EUGENE 

CHAP 


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GIFT  OF    MRS.  DOROTHY  CHAPMAN   TO   THE    U.C.L.A.   LIBRARY 


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BOOI^ 


ON 


The  Physician  Himself 


AND  THINGS  THAT  CONCERN 


His  Reputation  and  Success. 


BY 


D.  W-ICATHELL,  M.D., 

Baltimore,  Md. 


'■'  I'd  sketch  the  workl  exactly  as  it  goes." 


teisctk:  h:iditio]sc. 

Carsfu-lly  IE^e;-u-ise;ci  a.nd.  C3ri'e;<3.tly  HIn.la.rgsd.. 
(author's  final  revision.) 


Philadelphia,  New  York,  Chicago  : 
THE  F.  A.  DAVIS  COMPANY,  PUBLISHERS. 

1900. 


Entered  according  to  Act  of  Congress,  in  the  year  1892,  by 
THE  F.  A.  DAVIS  COMPANY, 
la  the  Office  of  the  Librarian  of  Congress,  at  Washington,  D.  C,  U.  S.  i 
All  rights  reserved. 


Philadelphia,  Pa.,  U.  S.  A.: 

The  Medical  Bulletin  Printing  House, 

1916  Cherry  Street. 


TO    THE 

YOUNGER  MEMBERS  OF  OUR  PROFESSION, 

AND 

ALSO  TO  THE   OLDER  ONES 

Who  Have  Paused  at  Less  than  the  Average  Degree  of 
Success  in  Life, 

this   little   book   is 

CORDIALLY  DEDICATED, 

With  the  Hope  that  All  Who  Study  its  Pages 
May  be  Benefited  by  it. 


"Reject  it  not,  although  it  hring 
Appearances  of  some  fantastic  thing 
At  first  unfolding  1" 


PREFACE  TO  THE  TENTH  EDITION. 


Impressed  with  the  belief  that  a  "Book  on  the  Physician 
Himself  and  Things  that  Concern  His  Reputation  and  Success  " 
would  be  of  decided  benefit  to  numerous  members  of  the  pro- 
fession, and  finding  no  such  work  extant,  I,  with  difiidence, 
attempted  the  duty  of  writing  one.     This  book  is  the  result. 

The  marked  favor  with  which  it  has  been  received  by  the 
medical  press,  the  expressions  of  approval  by  many  well-known 
members  of  the  profession,  and  the*  demand  for  edition  after 
edition  of  it,  are  taken  as  proof  that  such  a  work  was  greatly 
needed,  and  that  it  is  finding  its  way  into  the  hands  of  many 
of  those  for  whom  it  was  written. 

Grateful  for  this  kind  reception,  and  desiring  to  render  it 
more  worthy  of  the  flattering  commendations  it  has  received, 
I  have  very  carefully  revised  this,  the  tenth  edition,  and  have 
also  added  a  great  deal  of  new  material  that  greater  experience 
and  further  reflection  have  dictated. 

I  beg  you  to  judge  it,  good  reader,  not  by  opening  it  here 
or  there,  nor  by  glancing  at  detached  paragraphs ;  but  read  it 
through,  from  cover  to  cover,  or,  better  still,  study  its  pages, 
and  thus  qualify  yourself  to  weigh  correctly  its  teachings,  which 
I  would  fain  have  to  harmonize  with  the  advice  given  by  the 
Bishop  of  Lonsdale  to  those  who  came  to  him  inquiring  the 
way  to  heaven:  "Turn  to  the  right,  then  go  straight  forward." 

D.  W.  C. 

1308  N.  Charles  Street, 
Baltimore,  Md. 


book: 

ON 


THE  PHYSICIAN  HIMSELF 

AND   THINGS   THAT   CONCERN 

His  Reputation  and  Success. 


CHAPTER  I. 

"These  are  my  thoughts;  I  miglit  have  spun  them  out  into  a  greater 
length  ;  but  I  think  a  little  plot  of  ground  thick  sown  is  better  than  a 
great  field  which,  for  the  most  part  of  it,  lies  fallow." 

To  FIGHT  the  battles  of  life  successfully,  it  is  as  necessary 
for  even  the  most  skillful  physician  to  possess  a  certain  amount 
of  professional  tact  and  business  sagacity  as  it  is  for  a  ship  to 
have  a  rudder.  There  are  gentlemen  in  the  ranks  of  our  pro- 
fession who  are  perfectly  acquainted  with  the  scientific  aspects 
of  medicine,  and  can  tell  you  what  to  do  for  almost  every  ail- 
ment that  afflicts  humanity,  yet,  nevertheless,  after  earnest  trial, 
have  failed  to  achieve  reputation  or  acquire  practice  simply  be- 
cause they  lack  the  professional  tact  and  business  sagacity  that 
would  make  their  other  qualities  successful ;  and  there  is  noth- 
ing more  pitiful  than  to  see  a  worthy  physician  deficient  in 
these  respects,  waiting  year  after  year  for  practice,  and  a 
consequent  sphere  of  professional  usefulness,  that  never  come. 

Were  any  such  graduate  to  ask  me:  "  How  can  I  conduct 
myself  in  the  profession,  and  what  honorable  and  legitimate 
means  shall  I  add  to  my  scientific  knowledge  and  book-learn- 
ing, in  order  to  make  my  success  in  the  great  professional 
struggle  more  certain,  more  rapid,  and  more  complete"?"  I 
should  offer  him  the  foUowino:  suijgestions : — 

First,  last,  and  in  the  midst  of  all,  you  should,  as  a  man 

(1) 


2  THE   PHYSICIAN    HIMSELF: 

and  as  a  physician,  found  your  expectations  of  success  on  your 
personal  and  scientific  qualifications,  and  keep  whatever  is  hon- 
est, whatever  is  true,  whatever  is  just,  and  whatever  is  pure, 
foremost  in  your  mind,  and  he  governed  by  i't.  If  you  do  not 
you  will  not  deserve  to  succeed  in  the  honorable  profession  of 
medicine,  and  no  honest  man  can  wish  you  success. 

Whether,  after  graduation,  you  commence  to  practice  with- 
out any  intermediate  course,  or  wisely  strive  to  further  prepare 
and  refine  and  broaden  yourself  for  your  life's  work  by  a  limited 
term  of  service  as  resident  physician  or  assistant  in  some  hos- 
pital, or  by  taking  a  systematic  course  in  diagnosing,  prescribing, 
and  manipulations  at  some  post-graduate  school  in  one  of  our 
own  great  cities,  or  endeavor  to  obtain  a  complete  scientific 
knowledge  of  the  profession  by  making  a  journey  to  the  hos- 
pitals and  clinics  of  London,  Paris,  Berlin,  Vienna,  or  Leipzig, 
that  your  eyes  may  see  the  work,  and  that  your  ears  may  drink 
in  the  thoughts  of  their  great  teachers,  is  a  matter  of  taste, 
money,  time,  and  opportunity;  but,  whenever  and  wherever  you 
commence  your  private  practice,  you  should,  above  all  else,  be 
seriously  in  earnest  and  strive  to  start  right,  and,  by  the  aid  of 
hope,  tireless  industry,  and  determination,  to  enter  promptly  on 
the  road  to  success;  for,  unless  you  gain  popular  favor  by  a 
wortliy  display  of  ability,  acquire  some  reputation,  and  build 
up  a  fair  practice  in  your  first  six  or  eight  years,  the  probabilities 
are  that  you  never  will.  In  the  battle  of  life  it  is  not  simply 
the  events  of  school  days  and  college  hours,  but  the  after- 
performances,  that  prove  the  physician. 

"Life  is  a  sheet  of  paper,  white, 
Whereon  each  man  of  ns  may  write 
His  word  or  two,  and  then  conies  night." 

Beware  of  entangling  alliances.  It  is,  as  a  rule,  better  not 
to  enter  into  partnership  with  other  physicians.  Partners  are 
usually  not  equally  matched  in  industry,  capacity  for  work, 
tact,  temperament,  and  other  qualities  indispensable  to  an  inti- 
mate and  congenial  fellowship,  and  are  not  equally  cared  for  by 


HIS    REPUTATION    AND    SUCCESS.  6 

the  public.  Pleuce  such  professional  alliances  do  not  generally 
prove  as  beneficial  or  us  satisfactory  as  expected,  and  conse- 
quently partnerships  rarely  continue  long.  Above  all  else, 
never  ally  yourself  with  any  other  pliysician  as  assistant  or 
junior  partner,  to  do  the  drudgery,  or  on  any  other  terms  than 
as  an  equal.  The  sooner  you  learn  to  depend  wholly  on  your- 
self, the  better.  Julius  CsBsar  said :  "  I  had  rather  be  the  first 
man  in  a  village  than  the  second  man  in  a  great  city." 

"The  fame  that  a  man  wins  himself  is  best; 
That,  he  may  call  his  own." 

Unless  you  have  the  locality  and  your  place  of  residence 
already  selected,  you  may  find  it  the  most  difficult  problem  of 
your  life,  with  the  whole  boundless  continent  before  ^-ou,  to  ac- 
curately balance  and  weigh  the  difficulties  and  advantages  of 
this,  that,  or  the  otlier  nook,  corner,  or  opening.  Whether  to 
locate  in  your  own  town,  among  the  generation  you  have  grown 
up  with,  and  where  everybody  knows  all  about  you  and  your 
pedigree  from  the  cradle  up,  or  elsewhere,  among  strangers ;  in 
a  populous  city  or  moderate-sized  town,  or  in  a  village  or  a 
rural  district ;  in  the  East  or  the  West,  the  North  or  the  South 
of  our  wide-spread  land,  is  truly  a  puzzling  puzzle,  and  may  be 
the  turning-point  in  your  life. 

Many  big  blunders  are  made  at  the  outset  by  locating  in  the 
wrong  place  ;  therefore,  give  the  subject  your  very  best  thought, 
and  decide  with  great  care,  and  only  after  duly  considering 
your  own  qualities  and  qualifications,  as  well  as  the  locations, 
— whether  you  are  self-reliant  and  pushing,  or  quiet  and  unob- 
trusive ;  whether  you  have  abilities  that  will  enable  you  to  com- 
pete with  the  wisest  and  the  best,  and  compel  people  in  a  popu- 
lous centre  to  employ  you  in  preference  to  your  neighbors ;  or 
whether,  being  less  fully  armed,  you  had  better  be  satisfied  with 
mediocrity,  and  become  a  modest  country  doctor  in  a  less 
thickly  settled  location,  where  there  is  less  competition  and  less 
talent  to  encounter,  or  go  to  the  new  States  and  grow  with  the 
growth  of  the  settlements,  or  rise  with  the  villages,  or  spread 


4  THE   PHYSICIAN    HIMSELF  I 

with  the  cities  that  are  springing  up.  I  may  remind  you,  how- 
ever, that 

"Where  there  is  nothing  great  to  be  done,  a  great  man  is  impossible." 

Medicine,  hke  everything  else,  thrives  best  in  good  ground. 
By  all  means  seek  to  locate  in  a  community  to  which  you  are 
suited ;  that  will  be  congenial  as  a  place  to  live  in,  and  in  which 
you  are  likely  to  get  business  and  be  useful  to  your  fellow- 
beings,  and  also  to  earn  a  living  for  yourself.  Bear  in  mind 
that  unpopular  opinions  in  politics  or  religion  injure,  and  that, 
all  else  equal,  you  will  be  more  likely  to  succeed  and  be  con- 
tented in  a  section  where  your  views,  habits,  and  tastes  are 
naturally  in  harmony  with  the  bulk  of  the  people,  morally, 
socially,  and  politically. 

No  matter  where  you  start,  if,  alas ! 

"  You  wear  the  bloom  of  youth  upon  your  cheek," 

you  will  hear  the  adjective  "young"  oftener  than  is  pleasant, 
and  encounter  up-hill  difficulties  that  older  physicians  do  not. 
"  He  looks  too  young ;"  "  He  lacks  experience ;"  "•  He  don't 
know  anything;"  "He  has  no  practice,  therefore  is  no  good;" 
"  He  shouldn't  doctor  me,"  and  "  I'd  send  him  off  and  get  an 
older  physician,"  are  among  tlie  often-heard  expressions.  Face 
them  all  bravely.  Never  doubt,  but  show  the  world,  by  good 
management  and  good  habits,  that  you  deserve  to  succeed,  and 
success  will  surely  come.  Strict  attention  to  the  opportunities 
that  will  present  themselves  for  winning  confidence  in  cases 
that  are  incidentally  thrown  into  your  hands,  and  a  diligent 
cultivation  of  your  talents,  with  promptness,  civihty,  courtesy, 
and  unobjectionable  conduct  to  all,  rich  and  poor,  and  pleasant 
manners,  but  no  time  to  gossip,  will  bring  it.  Even  a  single 
event,  or  an  accident,  may  fortunately  give  you  an  introduction 
to  extensive  business. 

If  you  are  young  and  youthful-looking,  unless  you  have 
some  special  reason  to  the  contrary,  let  your  beard  grow,  if  it 
will ;  and  remember  that  our  Saviour  and  Alexander  each  Hved 


HIS   REPUTATION    AND    SUCCESS.  5 

but  thirty-three  years,  and  Napoleon  commanded  the  army  of 
Italy  at  twenty-seven. 

If  you  begin  practice  in  a  city  or  town,  the  location  and 
appearance  of  your  office  will,  more  or  less,  affect  your  progress, 
and  you  will  do  well  to  select  one,  easy  of  access,  in  a  genteel 
neighborhood,  upon  or  very  near  one  or  more  of  the  main  thor- 
oughfares, and  convenient  to  either  a  densely  populated  old  sec- 
tion, or  a  rapidly  growing  new  one.  The  nearer  to  busy  centres 
of  mechanics  and  laborers,  the  better.  If  you  were  to  locate  on 
a  back  or  unfrequented  street  or  other  out-of-the-way  place,  or 
in  the  country,  where  the  land  is  unproductive  and  the  population 
sparse,  simply  because  there  is  but  little  or  no  competition,  it 
would  naturally  suggest  to  the  public  that  you  had  poor  judg- 
ment or  were  made  of  timorous,  negative  material,  or  lacked 
the  spirit  of  enterprise  and  entliusiasm,  or  were  waiting  for 
])ractice  to  come  naturally,  and  for  success  to  be  handed  to  you 
on  a  silver  platter,  or  else  had  defective  ambition  and  distrust 
of  your  own  acquirements. 

"  He  tlmt  does  not  show  himself  is  overlooked." 

Remember,  in  making  your  selection,  that  a  physician  can- 
not rely  on  his  near  neighbors  for  patronage ;  Y)eople  in  your 
immediate  neighborhood  may  never  employ  you,  while  some 
farther  away  will  have  no  one  else. 

If  your  first  location  disappoints  you,  remove  to  another; 
but  avoid  frequent  removals,  and  do  not  shift  or  change  from 
one  place  to  another  unless  it  is  clearly  to  better  yourself. 
Select  a  place  suited  to  your  abilities  and  taste,  and  then  bo 
tenacious.  Reputation  is  a  thing  that  grows  slowly,  and  every 
distant  removal  imperils  one's  practice,  necessitates  new  labor, 
and  sometimes  even  compels  a  commencing  of  life  over  again. 
A  physician's  frequent  removals  may  also  create  a  bad  imprcs- 
>ion,  and  look  like  natural  instability  or  dissatisfaction  from 
lack  of  success. 

Branch  offices  are,  as  a  rule,  not  desirable,  for,  in  addition 
to  the  loss  of  time,  and  wear  and  tear  in  going  to  and  fro,  and 


6  THE   PHYSICIAN    HIMSELF: 

double  trouble  in  general,  they  are  apt  to  create  an  uncertainty 
in  the  minds  of  those  who  may  be  in  want  of  the  physician,  as  to 
where  and  when  he  is  most  likely  to  be  found.  On  estimating 
all  the  advantages  and  disadvantages,  it  will  probably  be  found 
that,  as  a  rule,  a  plurality  of  offices  increases  greatly  neither 
one's  practice,  one's  popularity,  nor  one's  income,  but  does  add 
greatly  to  the  labor,  and  hence  may  be  regarded  as  likely  to 
prove  more  annoying  than  profitable. 
It  has  been  said  that 

"A  physician  never  gets  bread 
Till  he  has  no  teeth  to  eat  it." 

Be  this  as  it  may,  it  is  risky  for  you,  if  a  beginner,  with  no 
influence  and  but  little  money,  to  locate  in  a  section  already 
overstocked  with  popular,  energetic  physicians,  as  their  superior 
advantages,  established  reputations,  and  warm  competition  may 
keep  you  limited  and  crippled  for  too  long  a  time  before  a  chance 
or  a  change  comes.  Also,  guard  against  going  too  close  to  large, 
free  hospitals  and  dispensaries.  Your  first  necessity  is  to  possess 
knowledge  and  skill  as  a  pliysician,  your  second  is  to  find  a 
field  in  which  to  exercise  and  display  them ;  but,  no  matter 
where  you  locate,  if  you  expect  business  immediately  to 
follow  your  annunciation  of  being  ready  to  receive  it,  you 
will,  except  under  very  extraordinary  circumstances,  be  rudely 
disappointed. 

A  corner  house  is  naturally  preferable  to  one  in  the  middle 
of  a  row,  since  it  is  convenient  for  persons  coming  from  all 
directions,  and  not  only  has  facilities  for  constructing  an  office 
entrance  on  the  side  street,  leaving  the  front  door  free  for  other 
callers,  but  also  insures  to  the  consulting-room  a  good  light  for 
examinations,  operations,  and  study. 

Regarding  offices :  Try  to  have  a  good,  comfortable  waiting- 
room,  with  a  recessed  front  door ;  also,  a  good,  light,  airy, 
and  accessible  consulting-room  of  moderate  dimensions,  with,  if 
at  all  convenient,  two  doors, — one  for  the  entrance  and  the  other 
for  the  exit  of  patients, — for  many  of  those  who  consult  you  will 


HIS   REPUTATION    AND    SUCCESS.  I 

prefer  to  be  let  out  through  a  passage  or  private  door,  and  thus 
escape  the  gaze  and  possibly  the  comments  of  others  in  waiting. 

Exercise  special  care  in  their  arrangement;  give  them  a 
pleasing  exterior  and  make  them  look  fresh,  neat,  and  clean  out- 
side; and  inside,  give  them  a  snug,  bright,  and  cosy  medical 
tone,  and  let  their  essential  features  show  that  their  occupant  is 
possessed  of  good  taste  and  gentility,  as  well  as  learning  and 
skill ;  and  that  tliey  are  not  a  lawyer's  consulting-rooms,  nor  a 
clergyman's  sanctum,  nor  an  instrument-maker's  shop,  nor  a 
smoking-club's  head-quarters,  nor  a  sportsman's  rest,  nor  a  loaf- 
ing room  for  the  gay,  the  idle,  the  dissipated,  and  the  unem- 
ployed ;  nor  a  family  parlor,  nor  a  social  meeting-place  of  any 
kind ;  but  the  offices  of  an  earnest,  working,  scientific  physician, 
who  has  a  library,  takes  the  journals,  and  makes  full  use  of 
the  instruments  and  methods  that  science  has  devised  for  him, 
and  regards  his  office  as  the  twin  sister  to  the  sick-room. 

Take  particular  care,  however,  to  avoid  making  a  quackish 
display  of  instruments  and  tools,  and  keep  from  sight  such 
inappropriate  and  repulsive  objects  as  catheters,  syringes,  stom- 
ach-pumps, obstetric  forceps,  splints,  trusses,  amputating  knives, 
skeletons,  grinning  skulls,  jars  of  amputated  extremities,  tumors, 
manikins,  the  unripe  fruit  of  the  uterus,  etc.  Also,  avoid  such 
chilling  or  coarse  habits  as  keeping  vaginal  specula  or  human 
bones  on  your  desk  for  paper-weights. 

But  while  you  should  make  no  undue  exhibition  of  books, 
surgical  instruments,  etc.,  it  is  not  unprofessional  to  have  about 
you — not  for  display,  but  for  ready  and  actual  use — your  outfit : 
microscope,  stethoscope,  laryngoscope,  ophthalmoscope,  spirit- 
lamp,  test-tubes,  reagents  for  testing  urine,  and  the  various  other 
aids  to  precision  in  diagnosis,  and  the  numerous  instruments 
you  make  use  of  in  treatment ;  also,  to  ornament  your  office 
with  diplomas,  certificates  of  society  membership,  potted  or 
cut  flowers  or  growing  plants  or  vines,  fine  etchings,  pictures 
of  eminent  professional  friends  or  teachers,  or  of  medical  celeb- 
rities,— Hippocrates,  Galen,  Harvey,  Gross,  or  whomever  else 


8  THE   PHYSICIAN    HIMSELF: 

you  specially  admire;  academical  prizes,  professional  relics, 
keepsakes,  mementoes,  medals,  or  anything  else  that  tells  of 
your  mental  or  physical  prowess  in  earlier  days,  or  is  specially 
associated  with  your  medical  studies  and  career.  But,  unless  it 
be  a  few  artistic  ornaments  or  works  of  art,  it  is  better  to  limit 
such  articles  to  those  having  relation  to  you  as  a  student  or 
physician. 

In  buying  your  office  outfit  see  that  the  walls  and  floors 
are  tastefully  covered.  Articles  of  furniture  should  be  few  in 
number,  but  good,  including  a  small,  and  if  means  will  admit, 
handsome  book-case,  with  writing-table  and  chairs  to  correspond. 
Have  comfortable  chairs  for  your  patients'  use,  so  arranged  that 
they  may  sit  in  a  good  light  during  examination,  but  beware 
of  stocking  yourself  with  novelties  and  instruments  that  will 
probably  go  out  of  fashion  or  rust  or  spoil  before  you  will  need 
them.  It  is  prudent  not  to  invest  heavily  at  first,  and  to  wait 
and  buy  none  but  the  usual  every-day  instruments,  which  the 
urgency  of  certain  cases  will  not  give  you  time  to  go  for,  when 
occasion  arises  for  their  use,  until  you  have  a  use  for  others. 
Bear  in  mind  that  soft-rubber  goods,  and  soft  goods  generally, 
deteriorate  and  finally  become  worthless  in  keeping. 

A  neat  case  of  well-labeled  and  well-corked  medicines,  or  a 
cabinet  of  minerals,  is  of  use  and  not  unornamental;  so  also 
are  dictionaries,  encyclopaedias,  and  lexicons  for  ready  reference ; 
also,  a  non-striking  time-piece  to  quietly  notify  the  time  to 
physician  and  patient  by  its  tick-tick-tick  ;  but  display  no  minia- 
ture museum  of  sharks'  heads,  stufied  alligators,  tortoise-shells, 
impaled  butterflies,  bugs,  ships,  steam-boats,  mummies,  snakes, 
fossils,  stuffed  birds,  lizards,  crocodiles,  beetles,  tape-worms,  devil- 
fish, ostrich-eggs,  hornets'  nests,  or  anything  else  that  will 
advertise  you  in  any  other  light  than  that  of  a  physician.  It 
will,  to  the  thinking  portion  of  the  public,  seem  very  much 
more  appropriate  for  you,  as  a  physician,  to  be  jubilant  over  a 
r(;stored  patient  or  a  useful  medical  discovery  than  to  be  ecstatic 
over  a  stuffed  flying-fish,  an  Egyptian  mummy,  or  a  rare  shell. 


HIS   REPUTATION    AND    SUCCESS.  S^ 

If  you  have  a  natural  love  for  such  incongruous  things,  or  are 
a  bird-  or  dog-  fancier,  or  a  bug-hunter,  at  least  keep  the  fact 
private  and  keep  your  specimens  out  of  sight  of  the  public,  and 
endeavor  to  lead  every  one  to  think  of  you  only  as  a  physician. 
It  is  your  duty,  as  well  as  your  interest,  to  display  no 
political  or  religious  emblems,  portraits,  etc.,  about  your  office, 
because  these  relate  to  your  personal  sentiments ;  being  em- 
phatically a  public  man,  and  your  office  a  public  place,  not  for 
any  special  class,  but  for  every  faith  and  party,  no  matter  what 
shade  of  partisan  or  sectarian  pictures  you  may  display,  they 
will  surely  be  repugnant  to  some, — 

"On  life's  stormy  ocean  diversely  we  sail," — 

and  in  this  and  other  matters  fairly  open  to  criticism  it  is  a  wise 
maxim  to  respect  public  opinion.  Difference  in  religion  or  poli- 
tics has  often  either  prevented  the  employment  of  physicians  or 
caused  their  dismissal,  and  the  obtrusion  of  unpopular  political 
or  religious  views  has  marred  the  prospects  of  many  a  physician ; 
besides,  what  is  popular  to-day  may  be  unpopular  to-morrow; 
therefore,  keep  your  heart  and  your  office  open  to  all  denomina- 
tions and  to  all  parties.     This  will  recommend  you  equally  to  all. 

Establish  a  regular  professional  and  business  policy  at  the 
beginning  of  your  career.  Be  at  your  post  as  punctually  as  pos- 
sible, and  have  your  office  lighted  regularly  every  evening  at  tlie 
proper  hour,  your  door-bell  answered  promptly,  professional 
messages  entered  on  the  slate  by  the  person  in  charge,  and  in 
all  other  respects  show  punctuality  and  system.  You  will  find 
that  absence  from  your  office  when  needed,  particularly  if  away 
tor  .sport  or  pleasure,  is  a  fruitful  source  of  loss  of  practice ;  if, 
on  the  contrary,  you  are  at  your  post,  people  will  credit  you 
with  seriousness  in  your  profession,  which  will  advertise  you 
and  bring  you  patronage. 

Do  not  allow  the  ladies  of  the  family  to  lounge  about  your 
office,  or  read  your  books,  answer  the  office-bell,  etc.,  lest  it  re- 
pel certain  kinds  of  desirable  patients.  Both  messengers  and 
patients  would  rather  meet  you  or  your  servant  than   ladies. 


10  THE   PHYSICIAN    HIMSELF: 

You  should  respect  public  opinion  in  this  and  in  all  other 
matters  justly  open  to  criticism. 

Still  more  important  to  success  will  be  the  morals  of  the 
companions  you  make  in  your  early  career;  in  fact,  all  through 
life  a  physician  is  judged  by  the  company  he  keeps.  Avoid 
associating  with  aimless  idlers  and  those  who  bear  a  merited 
stigma,  or  are  notoriously  deficient,  or  whose  hopes  and  ambi- 
tions have  been  blighted  or  wrecked  by  intemperance ;  or  their 
good  names  otherwise  tarnished  by  their  own  misconduct.  On 
the  contrary,  let  your  associations  be,  as  far  as  possible,  with 
professional  bretliren  and  people  of  genuine  worth.  Prefer  to 
spend  your  unoccupied  moments  in  your  office  with  your  stand- 
ard works  and  medical  journals,  or  in  rational  conversation  with 
high-minded  friends,  or  otlier  physicians,  or  at  medical  meet- 
ings, or  at  the  medical  library,  to  lounging  around  drug-stores, 
hotel-bars,  saloons,  club-rooms,  cigar-stores,  billiard-parlors, 
barber-shops,  or  corner-groceries,  with  lazy  fellows,  who  love 
doing  nothing,  frivolity,  and  dissipation  ;  or  to  taking  such  per- 
sons out  riding  in  your  carriage,  or  to  the  horse-races,  or  to  join 
the  throng  at  the  base-ball  game.  No  ordinary  man  ever 
conceives  a  more  exalted  opinion  of  a  professional  man  by 
fraternizing  with  him  at  such  places,  or  in  seeing  him  in  such 
company. 

As  a  further  but  minor  aid  to  successful  progress,  be  court- 
eous to  all  kinds  of  patients  with  whom  necessity  or  duty  brings 
you  into  contact;  but  while  you  treat  all  men  as  brothers,  and  all 
women  as  sisters,  beware  of  talking  too  freely,  and  do  not  hand- 
shake and  harmonize  and  associate  with  the  coarse,  ignorant, 
and  unappreciative  indiscriminately,  for  undue  familiarity  shears 
many  juniors  of  influence  and  prestige.  Also,  never  become  so 
familiar  as  to  lay  formality  aside  and  enter  a  patient's  house  or 
room  without  announcing  yourself  by  a  gentle  rap  or  ring  at 
the  door. 

Avoid  companionship  with  quacks  and  irregulars,  as  it 
would  detract  from  both  you  and  rational  medicine  which  you 


HIS    REPUTATION    AND    SUCCESS.  11 

represent  and  give  countenance  to  delusions  and  pretenders. 
Shun  this  and  every  other  contaminating  alliance  that  would 
confound  them  with  us  before  the  public. 

What  shall  be  said  regarding  self-mutilation  with  harlots 
and  association  with  varnished  concubines'?  Of  drinking  and 
of  gambling'?  Of  the  dethroning  fields  of  Venus  and  Bac- 
chus !  Oil !  physician,  if  you  have  entered  either  of  these 
Dx\NGEROUS  roads,  follow  the  dictates  of  common  sense,  and 
turn  from  it  this  day,  this  hour!  for  they  both  lead  rapidly 
downward,  and  either  of  them  will  deform  and  warp  all  your 
finer  sensibilities,  prove  fatal  to  every  ambition,  and  speedily 
put  a  death-blight  on  all  your  prospects.  And  if  indulging  any 
one  of  these  habits  singly  will  be  like  sowing  dragon's  teeth  for 
yourself,  what  will  be  the  combined  effects  of  them  all  1  It  will 
insure  social  and  moral  death!  Professional  suicide, — short, 
quick,  and  sure!  while  your  relatives  and  friends  will  weep  in 
all  the  bitterness  of  disap[)ointed  hope  for  your  dishonorable 
downfall. 

"Too  late  to  grieve  when  the  chance  is  past." 

An  unspotted,  honorable  name  is  the  only  thing  that  will 
render  your  life  happy  and  enable  you  successfully  to  withstand 
the  critics,  for  neither  you  nor  any  other  physician  can  success- 
fully lead  a  double  life,  or  afford  to  despise  public  opinion. 

"  A  pebble  in  the  streamlet  scant 
Has  turn'd  the  coarse  of  many  a  river." 

Unfortunate  acquaintances  have  been  the  downMl  and  ruin 
of  many  a  promising  young  physician  ;  therefore,  select  your  as- 
sociates with  great  care,  and  do  not  let  your  office  be  a  loung- 
ing place  or  a  smoking-room  for  horse-jockeys,  dog-fanciers, 
base-ballers,  politicians,  chatty  blockheads,  or  others  whose  time 
hangs  heavily  on  their  hands.  The  public  look  upon  physicians 
as  public  characters, — earnest,  sober,  studious  men,  with  scien- 
tific tastes  and  temperate  habits,  who  have  been  singled  out  and 
set  apart  for  a  lofty  purpose,  and  as  socially,  mentally,  and 
morally  worthy  of  an  esteem  not  accorded  to  such  people,  or 


12  THE   PHYSICIAN    HIMSELF: 

even  to  ordinaiy  citizens  engaged  in  the  private  business  of  life. 
The  idle  jokes,  childish  amusements,  boyish  gambols,  common- 
place gabble,  and  tone  of  thought  common  to  light-minded 
people  do  not  harmonize  with  the  studies,  tastes,  and  desires 
of  worthy  physicians,  and,  moreover,  tend  to  weaken  or  destroy 
the  faith  of  the  public,  which  is  so  essential  in  our  work,  for  on 
no  profession  does  faith  have  such  influence  as  on  ours.  You 
as  a  physician  are  public  property,  and  the  public,  and  especially 
the  female  portion  of  it,  with  eyes  like  a  microscope,  will  take 
cognizance  of  your  associations  and  of  a  thousand  other  little 
facts  regarding  you. 

"Things  small  in  themselves  have  often  a  far-reaching  significance." 

In  fact,  every  circumstance  in  your  appearance — dress,  manners, 
actions,  walk,  speech,  conversation,  habits,  where  you  are  to  be 
found  when  not  professionally  engaged,  etc. — will  be  closely 
observed  and  criticised  in  order  to  arrive  at  a  true  verdict,  more 
especially  in  the  early  years  of  your  career.  The  question  will 
never  be  asked  whether  you  were  graduated  at  the  new  or  the 
old  college,  or  whether  from  the  "college  of  wigs,  or  abroad," 
but  it  will  be,  "  Is  he  a  good  physician  ?" 

Put  not  a  feather's  weight  upon  the  honorable  ambition  of 
any  one,  or  a  straw  in  the  pathway  of  his  worthy  aspirations, 
but  be  very  cautious  how  you  involve  yourself  by  inducing 
persons  to  study  medicine,  as  there  are  already  three  physicians 
where  one  is  required.  Besides,  their  failure  in  the  profession, 
or  their  misconduct,  or  their  unfair  rivalry  may,  in  time  to 
come,  work  great  injury  to  you. 

"Out  of  a  white  egg  often  comes  a  black  chicken." 

Besides,  it  is  neither  profitable  nor  advisable  for  you,  a  private 
practitioner,  to  take  aspirants  for  ^sculapian  honors  as  office 
students,  as  they  will  necessarily  be  in  the  way  and  divert  your 
mind  from  other  duties  ;  but,  if  you  do  take  any,  charge  them  a 
fair  price  tor  the  privilege,  and  remember  that  in  taking  students 
you  stand  as  a  guardian  at  one  of  the  outer  gates  of  the  profes- 


HIS   REPUTATION    AND    SUCCESS.  13 

sion,  and  listen  only  to  such  applicants,  rich  or  poor,  as  have  a 
pure,  liigh-souled,  and  just  appreciation  of  the  profession,  well- 
balanced,  good  sense,  sobriety,  mental  and  physical  vigor,  good 
habits,  intellectual  capacity,  natural  aptitude,  and  a  strictly 
honorable  ambition  or  enthusiasm  to  be  a  worthy  phj'sician. 

Remember  that  you  cannot  polish  a  fungus  or  make  a 
sponge  shine,  and  that  good  gas  makes  a  good  light  and  bad  gas 
a  poor  one ;  that  a  good  battery  generates  good  electricity,  and 
that  a  bad  one  necessarily  makes  a  poor  kind ;  so,  also,  that  a 
good  brain,  a  good  mental  soil,  creates  better  ideas  and  bears 
better  fruit  than  an  ordinary  one.  A  high-thinking,  practical- 
minded  youth  from  the  corn-field  or  a  log-cabin,  with  scarcely 
enough  clothes  to  hide  his  nakedness,  and  the  aimless  son  of  a 
millionaire  may  each  apply.  If  you  take  either,  be  not  long  in 
choosing.  Brains  and  common  sense  are  a  rare  gift  from  heaven ; 
and  a  diploma  from  every  medical  college  on  the  face  of  the 
earth,  each  bedizened  with  ribbons — red,  white,  and  blue — and 
each  stowed  away  in  a  gold  case  set  with  diamonds,  cannot  give 
them  to  those  who  lack  them.  Bear  this  in  mind,  and  dissuade 
and  refuse  every  one  who  has  been  seduced  from  his  true  calling 
in  humble  life  to  embrace  medicine,  from  a  belief  that  its  study 
is  merely  a  pleasurable  pastime,  or  that  it  is  simply  a  trade,  or 
that  it  is  less  laborious  than  the  business  he  is  foUowins" :  or 
Jacks-at-all-trades,  who  are  tempted  to  add  M.D.  to  their  list,  by 
the  ease  with  which  a  "sheepskin"  can  be  obtained;  or  by  the 
false  notion  that  to  be  a  physician  is  a  gay  and  pleasant  life,  or 
a  smooth  and  rosy  road  to  money-making;  or  simply  to  please  a 
fond  grandmother,  or  a  doting  papa ;  or  from  a  false  dream  of 
an  easy  life.  Also,  turn  your  back  on  the  callous,  the  tough,  and 
the  ox-hearted,  rough-fisted  fellow,  who  boasts  that  he  is  stony, 
can  stand  anything,  and  wants  to  be  a  surgeon,  because  he  feels 
an  anxiety  to  see  the  shedding  of  human  blood,  or  any  other 
applicant  so  unworthy. 

The  popular  opinion  that  now  the  untilled,  thoughtless, 
brainless  bumpkin,  who  has  hardly  mastered  tlie  multiplication 


14  THE   PHYSICIAN    HIMSELF: 

table,  and  knows  not  the  difference  between  an  angle  and  a  tri- 
angle, can  stop  following  the  plough,  or  driving  the  jack-plane, 
or  drop  the  yard-stick,  or  pen,  or  teacher's  rod;  or  desert  his  lap- 
stone  and  bad  shoemaking  to-day  and  in  a  few  months  be  meta- 
morphosed into  an  M.D., — 

"While  all  who  know  him  wonder  how  he  passed," — 

and  that  an  ornamental  sign  or  a  fancy  door-plate  with  a  name 
(and  the  prefix  Doctor)  on  it,  with  a  buggy  at  the  door,  is  about 
all  that  is  necessary,  is  now  causing  thousands  of  young  men* 
to  quit  their  proper  avocations  in  life  and  study  medicine,  only 
to  fail  in  its  pursuit. 

In  getting  your  office  signs  or  door-plates,  remember  that 
a  physician  has  them  not  as  advertisements,  but  simply  to  show 
his  office  to  those  looking  for  him.  Your  signs  should  be 
neither  too  large  nor  too  numerous.  One  of  black  smalt  with 
jrold  letters  is  tlie  neatest  and  most  attractive  of  all ;  one  such 
sign  on  the  front  wall  for  the  day-time,  and  a  glass  one  with 
black  letters  in  the  window,  to  be  seen  at  night,  when  your 
office  is  lighted,  are  sufficient.  The  letters  On  the  former  should 
be  round  and  well  shaped,  and  not  more  than  two  inches  high, 
with  corresponding  width.  A  polished  brass  sign,  engraved  with 
your  name,  and  the  letters  filled  in  with  black,  and  mounted  on 
a  finished,  hard-wood  board,  is  also  neat  and  stylish. 

All  signs  should  be  neatly  made  and  correctly  lettered,  for 
even  one's  sign  makes  an  impression,  either  good  or  bad,  on 
the  public,  and  first  impressions  are  very  enduring. 

In  this  country  it  is  better  to  put  Dr.  ...  on  your  sign 
or  door-plate  than  to  put  .  .  .  ,  M.D.  "  Doctor  "  looks  better, 
and  is  understood  by  all ;  but  to  speak  of  yourself  as  a  phy- 
sician rather  than  a  doctor,  or  to  refer  to  your  professional 
brethren  as  physicians  ratlier  than  doctors,  sounds  more  dis- 
tinctive and  falls  better  on  the  ear. 

To  put  "  Physician  and  Surgeon "  or  "  Physician  and 
Accoucheur,"  or  other  compound  addition,  on  your  sign  would 
seem  unnecessary  in  this  region,  since  all   physicians  (except 


HIS   REPUTATION    AND    SUCCESS.  15 

the  specialists)  are  supposed  to  be  surgeons,  accoucheurs,  etc. 
The  practice  of  medicine  on  tlie  human  body  now  allows  no 
such  This-or-That  division  of  learning,  and  all  are  blended  by 
the  law ;  the  medical  case  of  to-day  may  be  the  surgical  or 
obstetrical  case  of  to-morrow ;  almost  as  well  might  the  confec- 
tioner's sign  say  "  Cold  Ice-Cream." 

Unless  your  name  is  likely  to  be  confounded  witli  that  of 
some  other  physician,  it  will  be  well  to  omit  your  given  name 
or  initials  from  your  signs  or  door-plate ;  but  it  sliould  be  on 
your  cards.  Of  course,  if  your  name  is  "  Smith,"  or  "  Jones," 
or  "  Brown,"  it  would  be  necessary  to  put  your  given  name  on 
your  signs ;  but  if  your  name  is  uncommon,  it  is  not.  People 
will  not  speak  of  Doctor  John  W.  Garfield,  but  of  Doctor 
Gai-field. 

Do  not  allow  otlier  people's  signs  of  tooth-drawing,  cup- 
ping and  leeching,  millinery,  dressmaking,  painting  and  glazing, 
boarding,  etc.,  in  company  with  yours. 

The  lettering  on  your  window-glass  may  be  protected  from 
being  scratched,  or  otherwise  defaced,  by  having  a  pane  of 
common  glass  placed  behind  the  lettered  one. 

It  is  deemed  unprofessional  to  state  where  you  graduated 
and  how  long  you  have  practiced,  upon  your  cards  and  signs, 
or  in  the  newspapers. 

Adopt  regular  office  hours  early  in  your  career,  and  post 
them  conspicuously  in  your  office ;  also,  have  them  on  your 
cards. 

It  may  be  a  question  whether  it  is  advantageous  to  have  a 
sign  designating  your  office  hours  on  your  office  window,  or  on 
the  house  front,  to  be  seen  by  the  outside  public.  Your  situa- 
tion in  business  should  influence  your  decision  on  this  point. 
A  young  physician,  or  one  who  has  much  spare  time  at  home, 
in  addition  to  his  stated  hours,  will  be  more  apt  to  catch  the 
overflow,  emergencies,  cases  of  accident,  calls  from  those  who 
are  strangers  in  the  city,  and  other  anxious  seekers  for  "any 
one,  so  he  is  a  physician,"  and  who  have  perhaps  searched  and 


16  THE   PHYSICIAN    HIMSELF: 

found  all  the  busier  physicians  away  from  their  offices,  if  an 
exhibition  of  his  office  hours  does  not  drive  them  off  by  telling 
them  before  ringing  the  bell  that  they  have  come  at  the  wrong 
time,  when  in  fact  he  is  at  home  wishing  for  calls.  On  the 
contrary,  one  busily  engaged  in  outside  practice,  who  has  no 
other  time  for  office  consultations  than  the  specified  hours,  can, 
by  displaying  them  outside,  regulate  his  business,  and  prevent 
various  annoyances,  by  letting  every  one  see  his  hours  before 

An  excellent  rule  is  to  direct  attention  to  both  the  begin- 
ning and  ending  of  your  office  consultation  hours,  as  :  "  Morning 
office  hours  begin  at  7  and  end  at  9  ;  afternoon  office  hours 
begin,"  etc.  Or :  "  Office  hours :  morning,  between  8  and  9 
o'clock  ;  afternoon,  between  1  and  3  o'clock,"  etc.  Many  people 
inconsiderately  think  that  as  your  office  hours  are  from  7  to  9, 
if  they  get  there  one  minute  before  9  o'clock  they  are  in  time ; 
whereas,  if  they  come  at  that  time  they  will  be  sure  to  keep  you 
past  your  hour  for  beginning  your  outside  professional  work. 
By  regulating  your  timp  trius,  and  constantly  urging  those  you 
attend  to  observe  your  home  hours  strictly,  you  can  accomplish 
doubly  as  much,  with  less  hurry  and  more  satisfaction  to  all. 
Indeed,  by  persistently  schooling  patients  to  observe  these  hours, 
and  to  send  for  you,  as  far  as  practicable,  before  your  accustomed 
time  for  starting  on  your  regular  rounds,  preferably  in  the 
morning,  you  will  do  much  to  systematize  your  business,  and 
to  lessen  the  number  of  calls  at  odd  and  inconvenient  times, 
which  do  so  much  to  increase  the  hardships  of  the  physician's 
life.  For  persistent  late-comers  to  come  strolling  into  a  busy 
physician's  office  for  advice  at  odd  or  unseasonable  hours,  or  at 
seasons  allotted  to  privacy  and  rest,  amounts  almost  to  persecu- 
tion. So,  also,  does  having  to  visit  the  same  neighborhood  half 
a  dozen  times  a  day,  in  consequence  of  his  patients  not  sending 
for  him  before  he  leaves  home  to  commence  his  rounds.  The 
time  allotted  to  office  patients  may  be  greatly  curtailed  by 
naming  certain  times  at  which  you  can  be  found  at  your  office ; 


HIS   REPUTATION    AND    SUCCESS.  17 

for  instance,  instead  of  having-  it  "  Morning,  from  8  to  9  o'clock  ; 
afternoon,  from  1  to  3  o'clock ;  evening,  from  6  to  8  o'clock," 
have  the  sign  read,  "  Office  hours :  morning,  about  8  o'clock  ; 
afternoon,  about  2  o'clock ;  and  evening,  about  1  o'clock,"  which 
times  are  easily  remembered,  and  will  cause  all  who  come  to 
get  there  about  those  hours. 

If  you  should  ever  get  very  busy,  and  be  pressed  for  time, 
your  sign  might  still  further  emphasize  it,  after  stating  your 
hours,  by  addnig,  "  No  office  consultation  at  other  hours." 

Have  a  slate  in  a  convenient  place,  whereon  messages  may 
be  left  during  your  absence  from  your  office,  and  have  over  it  a 
little  sign  something  like  this :  "  In  leaving  a  message  for  the 
Doctor,  be  careful  to  write  the  name,  street,  and  number." 

You  should  keep  a  supply  of  cards,  with  your  name,  resi- 
dence, and  office  hours  on  tliem.  An  inch  and  three-fourths  by 
three  inches  make  a  good  size. 

It  is  also  necessary  to  keep  a  supply  of  small  and  neat 
blank  bills,  and  to  have  envelopes  and  paper  with  your  name 
and  address  printed  on  them.  Let  your  bills  read,  "  For  pro- 
fessional services."  Blank  forms  for  use  in  giving  certificates 
to  sick  members  of  societies,  etc.,  are  also  very  useful.  Printed 
professional  certificates  look  much  better  and  more  formal,  and 
generally  give  more  satisfaction  tlian  written  ones. 

A  speaking-tube,  from  your  outside  office  door  to  your  bed- 
room, prevents  exposure  to  raw  night-air  at  an  open  window, 
and  is  of  great  utiUty  when  your  night-bell  rings. 

The  telephone  is  also  both  a  luxury  and  a  necessity.  Many 
physicians,  however,  are  deterred  from  having  one  by  the  fear 
that  it  will  cause  them  to  be  summoned  to  patients,  good  and 
bad,  at  a  distance  too  great  for  tliem  to  attend,  or  that  its  con- 
venience will  cause  annoying  calls  and  messages  to  be  sent  at 
unseasonable  hours.  This  belief  is  erroneous.  Tlie  telephone 
really  does  the  opposite,  and  enables  one  to  resist  the  arguments 
and  attempts  at  persuasion  so  often  encountered  in  personal 
interviews.     It  is,  moreover,  far  easier  to  decline  to  pay  a  visit, 


18  THE   PHYSICIAN   HIMSELF  I 

to  urge  a  plea,  to  suggest  a  remedy,  or  give  direct  instructions 
through  the  telephone,  than  by  an  interview  with  a  fallible  mes- 
senger. If  you  have  a  telephone,  put  its  number  on  your  cards, 
bills,  envelopes,  letter-paper,  etc. 

On  commencing  practice,  you  should  get  a  pocket  visiting- 
list,  a  cash-book,  and  a  ledger,  and  commence  to  keep  regular 
accounts  at  once,  taking  care  to  "  post  up  "  regularly  either 
weekly  or  monthly  ;  this  will  teach  you  system,  and  in  the 
course  of  time  save  you  thousands  of  dollars. 

Be  careful  to  record  the  iull  name,  occupation,  and  residence 
of  every  new  patient ;  for,  although  the  identity  of  this  one  and 
that  one  may,  at  the  time,  be  very  clear  in  your  mind,  yet  as 
patients  increase  and  multiply  and  years  elapse,  your  personal 
recollection  of  each  will  become  misty  and  confused,  and  conse- 
quently may  entail  on  you  considerable  money  loss.  Method  in 
business  is  one  of  its  chief  instruments.  Also,  never  neglect  to 
jot  down  memoranda  of  office  consultations,  payments,  new  calls, 
etc.,  in  your  visiting-list,  witli  a  lead-pencil,  until  you  get  an  op- 
portunity to  write  them  in  ink. 

One's  visiting-list  can  be  most  conveniently  carried  in  a 
wide  but  shallow  pants  pocket  on  the  left  hip. 

It  is  well  to  have  a  copy  of  the  fee-table  framed  and  hung 
in  a  suitable  place  in  your  office,  that  you  may  refer  patients  to 
it  whenever  occasion  requires.  It  is  also  wise  to  have  a  small, 
neat  sign,  with  "Office  Consultations  from  $1  to  $10,  cash," 
posted  in  some  semi-prominent  place  in  your  office.  It  will  show 
your  rule  and  tell  your  charge  ;  it  will  also  remind  any  who  might 
forget  to  pay  of  the  fact,  and  by  confronting  less  honest  people  will 
put  them  in  a  dilemma.  You  can,  when  necessary,  point  any  one 
to  it  and  ask  him  for  your  fee  ;  it  will  also  give  you  a  chance  to  let 
him  know  you  keep  no  books  for  office  patients.  Such  a  sign  will 
save  you  many  a  misunderstanding  and  many  a  dollar.  Of 
course,  you  may  omit  its  cash  enforcement  toward  patients  with 
whom  you  have  a  regular  account. 

Having  your  charge  from  "$l  to  $10  "  will  enable  you  to 


HIS    REPUTATION   AND    SUCCESS.  lt| 

get  an  extra  fee  for  cases  of  an  extvaordinaiy  character,  and  stiH 
allow  you  to  charge  minimum  fees  for  ordinary  cases.  Such  g, 
schedule  will  also  make  those  who  get  off  by  paying  the  lowest 
fees  feel  gratified,  and  will  show  everybody  that  you  assume  to 
be  skillful  enough  to  attend  $10  cases. 

Cultivate  office-consultation  prt\ctice  assiduously,  for  it  is  i\, 
fertile  source  of  reputation  and  of  cash  fees;  attending  such 
patients  as  are  able  to  go  out-doors,  at  your  own  office,  is  a  great 
saving  of  time  and  fatigue  to  the  physician.  Strive  to  benefit 
and  give  satisfaction  to  every  patient  who  comes  to  consult  you, 
that  every  one  may  go  away  impressed  with  a  belief  that  the 
nature  of  his  malady  is  clearly  recognized  and  understood,  and 
that  you  will  do  your  best  to  remedy  it ;  for  each  will,  while 
there,  form  some  definite  opinion  in  regard  to  you,  and  will  ever 
after  give  you  either  a  good  or  a  bad  name. 

Keep  a  small  case  of  medicines  at  your  office  representing  the 
most  frequently  employed  articles  of  the  pharmacopoeia,  espe- 
cially during  the  first  years  of  practice  ;  handling  them  will  not 
only  familiarize  you  with  their  appearance,  odor,  miscibility, 
taste,  and  other  characteristics,  but  also  enable  you  to  get  your 
fees  from  unreliable  patients,  and  such  others  as  can  appreciate 
advice  and  something  tangible  combined,  but  who  cannot  prop- 
erly value  advice  alone.  Besides,  by  keeping  cathartic  pills,  aro- 
matic spirits  of  ammonia,  lime-water,  morphia  granules,  etc., 
you  can  save  yourself  many  a  tramp  at  night,  during  storms,  on 
Sunday,  great  holidays,  at  odd  hours,  etc.,  by  sending  a  suitable 
remedy  by  the  messenger ;  and  give  the  patient  both  relief  and 
satisfaction,  till  you  can  go.  You  have  a  perfect  right  to  supply 
a  patient  with  medicine  if  you  choose.  Very  extensive  home 
dispensing,  or  running  a  rudimentary  drug-store,  or  a  pill  and 
globule  traffic,  however,  tends  to  consume  time  that  might  be 
much  better  employed,  and  to  dwarf  one  in  other  ways.  Fur- 
nishing his  own  medicines  does  not  pay,  if  a  physician  is  estab- 
lished in  good,  reliable  circles,  because  it  is  far  better  for  him  to 
base  his  charges  squarely  on  the  abstract  value  of  his  time  and 


20  THE   PHYSICIAN   HIMSELF! 

skill.  Besides,  one's  high  tariff  and  rough  compounding  would 
engender  the  criticism  and  enmity  of  neighboring  druggists  and 
others.  Never  under  any  circumstances  sell  medicines  to  any 
but  your  own  patients. 

Dispatch  every  professional  duty  promptly  and  punctually, 
so  as  to  get  it  out  of  the  way  of  wliatever  may  happen  to  come 
after.  When  summoned  to  cases  of  colic,  convulsions,  accident, 
etc.,  go,  if  possible,  immediately.  Then,  if  you  are  too  late  to 
be  of  service,  you  will  neither  have  cause  for  self-reproach  nor  be 
responsible  for  default  of  duty.  When  you  cannot  go  at  once 
without  neglecting  anotlier  pressing  case  that  has  a  prior  claim  on 
your  services,  or  other  duties  equally  as  urgent,  it  is  much  more 
satisfactory  to  your  patient  if  you  send  a  remedy,  with  instructions 
for  use  until  you  can  go,  than  to  write  a  prescription ;  because, 
to  send  a  prescription  in  such  cases  seems  rather  as  if  you  do 
not  sympathize,  or  as  if  the  patient  was  on  your  don't-care-to- 
attend  list,  and,  if  the  case  takes  an  unfavorable  turn,  or  does 
not  eventuate  favorably,  you  may  be  blamed  and  criticised. 

"Of  all  sad  words  of  tongue  or  pen, 
The  saddest  are  these  :  it  might  have  been." 

When  you  reach  a  patient  whose  friends  have,  in  the  ex- 
citement, sent  for  a  number  ot  physicians,  with  no  special  choice 
among  them,  it  is  well  to  have  them  promptly  send  a  trusty 
messenger  or  a  courteous  note  to  the  others  to  cancel  the  call 
and  save  them  trouble,  by  informing  them  their  services  will  not 
be  required. 

If,  at  your  office  and  elsewhere,  you  make  a  judicious  and 
intelligent  use  of  your  instruments  of  precision, — the  stethoscope, 
ophthalmoscope,  laryngoscope,  the  clinical  thermometer,  the 
tape,  the  microscope,  and  the  reagents  necessary  to  a  careful 
examination  of  tumors,  sputa,  calculi,  urinary  disorders,  etc., — 
they  will  not  only  assist  you  very  materially  in  diagnosis,  but 
will  also  aid  3^ou  greatly  in  curing  nervous  and  terrified  people, 
by  increasing  their  confidence  in  your  ability,  and  enlisting 
their  sympathetic  concurrence  in  your  remedial  treatment. 


HIS   REPUTATION  AND    SUCCESS.  21 

Always  carry  with  you,  in  your  professional  rounds,  a  good 
clinical  thermometer,  female  catheter,  bistoury,  hypodermatic 
syringe,  small  forceps,  lunar  caustic,  probe,  needles,  pen-knife, 
etc.,  lor  ready  use.  Keep  a  little  raw  cotton  in  the  case  with  your 
clinical  thermometer  to  protect  it  against  breakage,  and  never 
omit  to  wash  it  and  all  otlier  instruments  immediately  after  use. 

Be  especially  careful  to  avoid  syphilitic  inoculation,  septi- 
caemia, etc.,  and  never,  under  any  circumstances,  use  a  cut  or  an 
abraded  finger  in  making  vaginal  and  other  examinations ;  if 
your  preferable  hand  is  unsafe,  use  the  other.  Cosmolin  and 
vaselin  answer  a  good  purpose ;  they  have  no  affinity  for 
moisture,  and  both  keep  for  years  without  becoming  rancid  or 
decomposing.  Get  a  supply  of  either,  and  keep  it  in  your 
office  for  anointing  your  fingers,  instruments,  etc.  Wooden 
tooth-picks  and  cigar-lighters  are  also  very  handy  for  making 
mops,  applying  caustics,  etc.  Being  inexpensive,  each  one  can 
be  thrown  away  after  one  service,  instead  of  being  kept  for 
further  use,  as  must  be  done  with  expensive  articles. 

Knives,  probes,  needles,  and  other  instruments  can  be 
readily  cleaned  and  disinfected,  both  before  and  after  being  used, 
by  thrusting  them  several  times  through  a  wet,  well-soaped 
towel  or  rag,  or  into  a  cake  of  wet  soap. 

You  should  have  a  special  receptacle  in  your  office  for 
cast-off  dressings  from  cases  of  gonorrhoea,  syphilis,  septic  ulcers, 
and  other  filthy  affections,  which,  when  they  accumulate,  should 
be  burned. 

With  the  view  to  maintain  your  physical  health,  you  should 
endeavor  to  live  temperately  and  comfortably,  and  to  rest  as 
much  as  possible  on  Sundays  and  at  night ;  and,  moreover,  if 
you  would  avoid  the  risk  of  break-down  in  health,  as  happens 
to  hundreds  of  our  profession,  make  it  a  cardinal  point  of  duty 
to  yourself  and  family  to  get  your  meals  and  sleep  as  regularly 
as  possible,  and  to  keep  your  digestion  in  order ;  then  you  need 
have  but  little  fear  of  overwork. 

A  decent  respect  for  the  opinion  of  the  world  should  lead 


22  THE    PHYSICIAN    HLMSELF  : 

you  to  practice  all  that  constitutes  politeness  in  dress  and  de- 
portment. Keep  yourself  neat  and  tidy,  and  avoid  everything 
approaching  carelessness  or  neglect.  Do  not  altogether  ignore 
the  fashions  of  the  day,  for  a  due  regard  to  the  customs  prevail- 
ing around  you  will  show  your  good  sense  and  discretion. 
Even  though  the  prevailing  style  of  dress  or  living  borders  on 
tlie  absurd  or  extravagant,  it  mav  still  be  wise  to  conform  to  it 
to  a  certain  extent.     Young  says : — 

"Though  wrong  the  mode,  comply  ;  more  sense  is  shewn 
In  wearing  others'  follies  than  our  own." 

You  never  heard  of  a  designing  swindler,  or  a  confidence-man, 
or  a  gambler,  or  a  pseudo-gentleman  of  any  kind,  who  dressed 
shabbily  or  in  bad  taste,  for 

"These  men's  souls  are  in  their  clothes." 

Such  people  are  all  close  students  of  human  nature,  and,  no 
matter  how  abandoned  they  are,  no  matter  how  tarnished  in 
character  or  how  blackened  in  heart,  they  too  often  manage  to 
hide  their  deformities  as  with  a  veil  from  all  but  tlie  few  who 
know  their  true  characters,  by  assuming  the  dress,  manners, 
and  tone  of  gentlemen.  Now,  if  genteel  dress,  polished  man- 
ners, and  cultured  address  can  do  so  much  for  such  fallen  speci- 
mens of  mankind,  how  much  greater  influence  must  appear- 
ance, manners,  and  voice  exert  for  those  who  are  truly  gentlemen 
and  members  of  an  honorable  profession. 

Nevertheless,  do  not,  under  any  plea,  be  a  leader  or 
patroriizer  of  loud  or  frivolous  fashions,  as  though  your  starchy 
foppishness  and  love  of  fine  clothes  had  overshadowed  all  else ; 
discard,  also,  glaring  neckties,  flashy  breastpins,  loud  watch-seals, 
brilliant  rings,  fancy  canes,  cologne,  perfumes,  attitudinizing,  and 
all  other  Yjcculiarities  in  your  dress  or  actions  that  indicate  over- 
weening self-confidence,  or  a  desire,  with  the  assistance  of  the 
Graces,  to  be  regarded  as  a  man  of  fashion,  or  a  swell. 

"  Cupid,  have  mercy  !" 

Such  peacockish  individuals  may  be  admired,  but  they  are  not 
usually  chosen  by  discerning  persons  seeking  a  guardian  for  their 
health. 


HIS   REPUTATION   AND   SUCCESS.  23 

Even  though  you  be  ever  so  poor,  let  your  garb  show  gen- 
teel poverty,  for  every  physician's  dress,  manners,  and  bearing 
should  agree  with  his  noble  and  dignified  calling.  The  neglect 
of  neatness  of  dress  and  the  want  of  polite,  refined  manners 
might  cause  you  to  be  criticised  or  shunned.  You  Avill  some- 
times see  superficial  but  spruce  little  Dr.  Tact,  whose  head  is 
comparatively  empty,  who  always  sat  on  the  back  benches  at 
college,  succeed  in  getting  extensive  and  lucrative  practice,  and 
paying  heavy  bills  for  horseshoes,  almost  entirely  by  attention 
to  the  outer  trappings  and  aft'ability  of  manner ;  while  Dr.  Pro- 
fundus, Dr.  Alltrue,  and  Dr.  Talent,  professionally  more  able 
and  personally  more  worthy,  will  languish,  and  never  learn  the 
cost  of  carriages  and  the  price  of  horse-feed,  by  reason  of  defects 
in  these  apparently  trivial  matters.     Alas  ! 

"Veneering  often  outshines  the  solid  wood. 

Clean  hands,  well-shaved  face  or  neatly-trimmed  beard,  unsoiled 
shirt  and  collar,  an  imim  peach  able  hat,  polished  boots,  spotless 
cuff's,  well-fitting  gloves,  fashionable  clothing,  cane,  sun-um- 
brella, all  relate  to  personal  hygiene,  severally  indicate  gentility 
and  self-respect,  and  naturally  impart  to  their  possessor  a  pleas- 
urable consciousness  of  being  well  dressed  and  presentable. 

"lam  not  a  handsome  man,  but  my  beaver  doth  lend  me 
an  air  of  respectability." 

The  majority  of  people  will  employ  a  tidy,  well-dressed 
physician,  of  equal  or  even  inferior  talent,  more  readily  than  a 
slovenly  one ;  they  will  also  accord  to  him  more  confidence, 
and  expect  from  and  willingly  pay  to  him  larger  bills. 

Avoid  extraneous  pursuits  and  a  multiplicity  of  callings, 
especially  such  as  would  interfere  with  your  duties  as  a  phy- 
sician, or  would  give  you  a  distaste  for  the  profession,  or  cause 
you  to  resume  its  duties  vvith  a  feeling  of  irksomeness.  Divorce 
medicine  from  all  other  avocations,  however  important,  respect- 
able, or  lucrative, — from  the  drug  business,  dealing  in  petro- 
leum, or  salt,  or  cattle,  or  horses ;  nor  be  equally  interested  in 
the  practice  of  medicine  and  in  school-teaching,  or  in  pushing 


24  THE    PHYSICIAN    HIMSELF: 

the  jack-plane,  or  in  following  the  plow  ;  or  giving  public  read- 
ings, or  preaching,  scribbling  poetry  on  subjects  not  connected 
with  medicine,  or  fiddling  or  singing  at  concerts ;  or  base-ball 
playing,  rowing  matches,  amateur  photographing,  etc., — because 
the  public  cannot  appreciate  you  or  any  one  else  in  two  dissim- 
ilar characters  or  in  two  incompatible  pursuits :  half  physician 
and  half  druggist,  or  three-eighths  physician  and  five-eighths 
politician,  or  one-third  physician  and  two-thirds  sportsman,  or 
otlier  similar  mixture  of  incongruities:  for  it  is  in  medicine  as 
in  religion, — no  one  can  serve  two  masters.  Of  course,  if  you 
choose  to  change  off  and  quit  medicine  for  any  other  calling,  it 
is  legitimate  to  do  so ;  but  it  is  better  to  be  a  whole  one  thing 
or  another. 

Although  it  may  seem  paradoxical,  even  reputation  as  a 
surgeon  (though  surgery  is  but  a  branch  of  our  art),  or  as  a 
specialist  of  any  kind,  militates  decidedly  against  reputation  in 
other  departments  of  medicine.  The  public  in  general  believe 
that  a  surgeon,  with  his  sharp  saws  and  thirsty  knives,  delights  in 
spilling  blood,  and  is  good  only  for  ivhipping  q^' limbs,  or  other 
cutting  operations,  and  that  a  specialist  is  good  only  for  his 
specialty,  just  as  a  preacher  is  for  preaching. 

Hesitate  even  to  take  such  offices  as  vaccine  physician, 
coroner,  city-dispensary  physician,  sanitary  inspector,  etc.,  in  a 
section  where  you  expect  to  practice  in  future,  more  especially 
if  you  must  have  illiterate  political  demagogues  or  buffoons  for 
employers  or  companions. 

"Jack  in  office  is  a  great  man." 

All  such  functions  tend  to  dwarf  one's  ultimate  progress,  and 
sometimes  create  a  low-grade  reputation  that  it  is  hard  to  out- 
live. To  many  people,  taking  such  offices  for  the  fees  to  be 
obtained  looks  somewhat  like  a  confession  of  impecuniosity  or 
of  inferiority,  and  creates  an  adverse  impression  that  is  not  over- 
come for  years.  If  you  have  any  merit  at  all,  and  an  open  field, 
private  practice  industriously  followed  will  lead  by  better  roads 
to  greater  success. 


HIS    REPUTATION    AND    SUCCESS.  25 

The  last  remark  is,  also,  to  a  certain  extent  true  of  the 
position  of  permanent  physician  or  assistant  physician  to  hos- 
pitals, infirmaries,  lunatic  asylums,  dispensaries,  almshouses, 
reformatory  or  penal  institutions ;  or  in  the  army,  or  on  board 
eraig-rant  or  naval  vessels,  where  employment  in  a  snug  or  easy 
job,  at  a  petty  salary  and  the  comforts  of  a  home,  for  a  few  of 
his  most  precious  years,  have  caused  many  a  physician  fully 
qualified  for  success  as  a  practitioner  to  pass  the  flower  of  his 
days,  to  lose  the  best,  the  golden  part  of  his  life,  and  let  slip 
opportunities  that  could  never  be  recalled. 

"Too  soon,  too  soon 

The  noon  will  be  the  afternoon  ; 

Too  soon  to-day  will  be  yesterday." 

Bear  in  mind  that  such  positions  can  never  be  depended  on 
longer  than  those  in  power  find  it  to  their  interest  to  change. 

If  you  ever  become  a  teacher  of  medicine  in  a  college, 
with  a  choice  of  branch,  instead  of  taking  Physiology,  Ma- 
teria Medica,  Jurisprudence,  Hygiene,  or  other  non-personal 
subjects,  take  care  to  aim  for  a  practical  chair,  one  that  relates 
directly  to  the  sick,  and  that  is  likely  to  increase  your  skill, 
get  you  special  work  to  do,  or  otlierwise  advance  your  reputa- 
tion and  your  private  practice. 

Shun  politics  and  electioneering  tactics ;  for  politics,  even 
when  honorably  pursued,  are  injurious  to  a  young  physician's 
prospects ;  later,  when  his  medical  reputation  is  already  exten- 
sive, they  generally  lessen  his  professional  popularity,  although 
they  may  not  necessarily  ruin  him.  If  the  best  of  good  politics 
injure  thus,  how  much  worse  is  it  to  be  dabbling  in  the  dirty 
pools  of  partisan  politics,  at  ward  rallies  and  bar-room  confer- 
ences, or  plunging  into  demagogism,  and  wire-pulling,  slate- 
making,  log-rolling  and  pipe-laying  at  primary  meetings, 
caucuses,  conventions,  etc.,  with  "the  b'hoys."  No!  no!  thrice 
no  !  For,  besides  escaping  many  anxious  hours  and  bitter  dis- 
appointments, you  can  in  the  long  run  make  ten  friends  and 
ten  dollars  by  being  no  man's  man,  and  calmly  sticking  to  your 


26  THE   PHYSICIAN   HIMSELF: 

profession,  while  you  are  making  one  of  either  in  the  polluted 
and  polluting  waters  of  party  politics,  lending  your  name  to 
help  the  campaign,  or  intriguing  and  scrambling  for  office  with 
those  who  belong  to  the  parties  chiefly  for  their  loaves  and 
fishes. 

Array  yourself  on  the  side  of  morality,  virtue,  honesty, 
religion,  etc.,  but  neither  make  your  religion  nor  your  irreligion 
a  stepping-stone  to  practice,  and  never  join  a  church  or  a 
religious  society  for  the  purpose  of  gaining  popularity  or  church 
influence.  You  will  surely  find  that  society,  church,  political, 
and  other  special  groups  of  sectarian  patients,  gained  because 
they  belong  to  the  same  society  or  party  in  politics,  or  are 
affiliated  with  you  in  society  matters,  or  go  to  the  same  church, 
or  because  you  deal  with  them  in  business,  or  live  on  the  same 
street,  or  because  they  like  the  way  you  walk  or  dress,  rather 
than  through  appreciation  of  your  merits  as  a  physician,  are 
neither  very  profitable  nor  very  constant.  If,  instead,  you  will 
banish  everything  that  comes  between  you  and  your  legitimate 
work,  try  to  bring  practice  hy  your  practice,  and  cultivate  patients 
secured  promiscuously  from  all  parties,  and  from  every  direc- 
tion, because  they  believe  that  you,  as  a  physician,  possess  solid 
merit ;  and  have  faith  in  your  brain  and  your  heart  and  your 
hand ;  it  will  in  the  long  run  make  you  more  friends,  and  firmer 
friends,  and  pay  you  better  than  attending  solely  to  any  one 
political  sect  or  religious  creed,  or  following  any  other  outside 
issue. 

A  riding  physician  has  several  advantages  over  the  one 
who  makes  his  rounds  on  foot ;  not  only  is  he  able  to  see  a 
greater  number  in  a  given  time,  and  with  much  less  fatigue  to 
himself;  but  he  gets  rest  while  riding  from  one  patient  to 
another,  and  can  spend  the  time  in  thinking ;  can  collect  and 
concentrate  his  mind  more  fully  on  his  serious  and  puzzling 
cases  while  riding  than  if  walking,  and  when  he  reaches  his 
patient  he  is  in  good  mental  and  physical  condition  to  begin  his 
duties,  while  the  walking  physician  arrives  out  of  breath,  excited. 


HIS   REPUTATION   AND    SUCCESS.  2t 

and  in  need  of  rest.  The  former  can  prescribe  and  be  gone 
while  the  latter  is  waiting  to  regain  his  breath.  Another  con- 
venience is,  that  Tenderfoot  salutes  acquaintances  as  his  carriage 
meets  tliem  and  rides  on ;  whereas,  Trudger  is  compelled  to  stop, 
and  loses  valuable  time  in  conversing  with  convalescent  patients, 
old  friends,  and  others. 

You  sliould,  therefore,  get  a  good-looking  horse  and  a  gen- 
teel carriage  as  soon  as  your  circumstances  will  justify.  Such  a 
turn-out  is  not  only  a  source  of  health  and  enjoyment  in  the 
beginning  "of  practice,  but  getting  it  indicates  that  your  practice 
is  growing.  Many  persons  consider  success  the  chief  test  of 
merit,  and  prefer  a  much-employed  riding  physician  to  the  worn 
pedestrian.  This  is  one  of  the  reasons  why  any  one  can  ride 
into  a  full  business  much  quicker  than  he  can  walk  into  one. 
Besides,  the  inexperienced  public,  with  nothing  else  to  judge  by, 
infer  that  a  physician  who  finds  a  carriage  necessary  must  have 
an  extensive  and  successful  practice,  else  he  would  not  require 
and  covdd  not  afford  one. 

If  you  unfortunately  have  a  bony  horse  and  a  seedy-looking^ 
pre-Adamite,  dust-covered,  rust-eaten  kind  of  buggy,  do  not 
let  them  habitually  stand  in  front  of  your  office  for  hours  at  a 
time,  or  drive  a  vehicle  covered  with  last  week's  mud  or  clav,  as  if 
to  advertise  your  poverty,  lack  of  taste,  and  paucity  of  practice. 

If  you  have  two  horses,  and  two  only,  it  is  better  to  drive 
singly,  that  one  may  be  resting  while  the  other  is  working. 
Driven  thus,  two  good,  well-kept  horses  can  surely  carry  you 
to  as  many  patients  as  you  can  attend. 

If  a  pair  is  driven,  they  should  be  first-class ;  for  it  is  bet- 
ter to  use  one  genteel-looking  horse  to  a  handsome  phaeton,  than 
a  shabby  pair  to  a  rickety-looking  vehicle. 

Many  physicians  have  a  modest  monogram  or  their  initial 
letter  put  on  their  bridle-blinds  or  carriage-panels.  Such  desig- 
nations, when  within  bounds,  are  both  genteel  and  ethical. 

Either  have  a  person  with  you  to  mind  your  horse,  or  tie 
it  before  entering  your  patient's  house,  that  you  may  not  be 


28  THE   THYSICIAN    HIMSELF.* 

wondering  what  it  is  doing,  or  running  to  the  window  or  out  at 
the  door  at  every  noise,  to  see  whether  it  has  started  off  with 
the  carriage,  as  if  your  mind  were  more  on  it  than  on  the  patient. 
When  possible,  it  is  better  and  safer  to  keep  a  driver. 

While  it  is  perfectly  fair  and  proper  to  seek  reputation  by 
all  legitimate  means,  and  to  embrace  every  fair  opportunity 
to  make  known  your  attainments,  avoid  all  intriguing  and 
sensational  scheming  to  obtain  practice.  Attempts  to  puiF 
yourself,  your  cases,  your  operations,  or  your  skill,  into  celebrity, 
by  driving  ostentatious  double  teams,  or  having  a  flashily  liv- 
eried driver,  odd-shaped  or  odd-colored  vehicles,  close  carriages, 
conspicuous  running-gear,  loud  monograms,  flashy  plumes,  or 
oversized  initials  on  harness  or  carriage-panels,  or  blazed-faced, 
peculiar-looking  horses  or  ponies;  or  pretending  to  be  over- 
run with  business  by  driving  unnecessarily  fast,  as  though  the 
devil  were  in  chase,  book  in  hand,  attempting  to  read  as  the 
carriage  whirls  and  jolts  along ;  or  having  yourself  unnecessa- 
rily called  out  of  church,  at  the  stillest  and  most  solemn  part  of 
the  service — 

"You  assume  a  hurry,  if  you  have  it  not ;" 

and,  worse  still,  afl'ecting  odd-style  or  extra  wide  brim  hats,  long 
hair,  and  heavy  canes ;  .or  showing  everybody  afliected  kindness 
or  meddlesome  attention ;  and  other  vulgar,  mean,  and  dishonor- 
able attempts  to  pass  for  more  than  one  is  worth,  to  get  busi- 
ness,— all  generally  fail  in  their  object,  and  are  looked  upon  by 
many  as  either  an  illegitimate,  unethical  display  of  artifices  and 
tricks,  or  the  efl'orts  of  a  small  mind  or  of  a  weak  and  ig- 
norant Dr.  Sham  or  Dr.  Gullumall  to  hide  a  lack  of  ordinary 
skill,  or  to  get  oneself  talked  of,  and  actually  sometimes  bring 
him  who  aflects  them  into  ridicule  and  disrespect. 

"Full  many  a  shaft  with  purpose  sent, 
Finds  mark  the  archer  little  meant." 

Be  cautious  not  to  thus  belittle  yourself,  but  strictly  avoid 
ostentation  and  every  peculiarity  of  manner,  dress,  oflice  ar- 
rangement, etc.,  calculated  to  make  you  offensively  conspicuous. 


HIS    REPUTATION  AND    SUCCESS.  29 

and  excite  ridicule,  disrespect,  or  contempt.  On  the  other  hand, 
however,  if  you  are  bashful,  shame-faced,  diffident,  and  lacking 
in  aggressiveness  or  deficient  in  tact,  you  will  never  prosper 
until  these  disadvantages  are  overcome. 

In  medicine,  reputation  that  comes  easily  goes  easily.  Ac- 
cident or  trick  may  bring  one  into  notice,  but  they  cannot  sus- 
tain him,  and  he  is  finally  estimated  at  his  true  value.  The 
best  reputation  is  that  acquired  by  a  display  of  talent  and  merit. 
If  one  is  tossed  into  reputation  he  does  not  merit  he  will  surely 
sink  again  to  his  true  level.  Even  if  you  get  reputation  for 
distinguished  abilities  by  superior  talent,  and  desire  to  sustain 
it,  you  must  still  work  hard, — 

"A  great  reputation  is  a  great  charge," — 

and  from  time  to  time  present  additional  ideas  and  show  new 
proofs  of  possessing  talents  and  intellectual  strength. 

It  is  customary  and  proper  to  give  simple  notice  of  remov- 
als, recovery  from  prolonged  sickness,  return  from  long  jour- 
neys, etc.,  in  the  newspapers,  but  it  is  neither  legitimate  nor 
creditable  to  announce  your  entrance  into  practice ;  nor  to  ad- 
vertise yourself  generally  in  newspapers,  nor  to  placard  barber- 
shops, hotels,  etc.  Pufhng  yourself,  your  cases,  your  apparatus, 
your  skill,  or  your  fame,  through  the  medium  of  the  press,  and 
winking  at  being  puffed  and  applauded  in  the  newspapers,  are 
quackish,  stale,  unprofessional,  dishonorable,  and  on  a  par  with 
Dr.  Hugh  DeBrass  and  his  speckled-horse  plan.  A  proper 
pursuit  of  medicine  will  imbue  you  with  loftier  sentiments  and 
engender  nobler  efforts  to  gain  public  attention  and  to  get  your- 
self talked  of,  and  will  spur  you  to  build  your  fame  on  much 
stronger  foundations. 

Cultivate  the  true  art  and  spirit  of  professional  manner  and 
deportment.  Much  of  your  usefulness  and  comfort  will  depend 
on  it.  But  do  nothing  to  gain  popular  favor  that  does  not  ac- 
cord with  both  the  letter  and  spirit  of  the  ethical  code.  Inde- 
pendent of  the  degradation  you  would  feel,  it  would  not  pay  to 


80  THE   PHYSICIAN    HIMSELF; 

trust,  for  business,  to  tricks  of  any  kind;  for  the  veil  that  covers 
such  attempts  is  generally  too  thin  long  to  hide  the  real  motive 
or  to  turn  aside  ridicule. 

You  will  be  more  esteemed  by  patients  who  call  at  your 
office,  for  any  purpose,  if  they  find  you  engaged  in  your  profes- 
sional duties  and  studies,  than  if  reading  novels,  making  toy 
steam-boats,  chasing  butterilies,  or  occupied  in  other  non-profes- 
sional or  trivial  pursuits ;  even  reading  the  newspapers,  smoking, 
etc.,  at  times  proper  for  study  and  business,  have  an  ill  effect  on 
public  opinion,  which  is  the  creator,  the  source  of  all  reputation, 
whether  good  or  bad,  and  should  he  respected ;  for  a  good  rep- 
utation is  a  large,  a  very  large,  yea,  sometimes  the  cliief  part 
of  a  physician's  capital. 

It  is  very  natural  to  expect  your  near  medical  neighbors  to 
pay  you  a  visit  of  courtesy  after  you  commence  practice,  or 
change  your  location  ;  for  the  purpose  of  establishing  reciprocal 
and  friendly  intercourse,  whether  previously  acquainted  or  not ; 
but  if  they  fail  to  do  so,  it  should  not  be  too  quickly  construed 
as  discourtesy  or  ill-will,  for  it  may  be  due  to  their  position  of 
doubt  concerning  your  being  a  regular  physician ;  or  they  may 
deem  it  your  duty  to  make  the  first  call,  to  announce  your  in- 
tention to  practice  in  the  locality,  and  to  tell  of  your  honorable 
business  hopes  and  ethical  intentions,  and  to  ask  for  kindly, 
courteous  treatment ;  or,  they  may  wish  time  to  scrutinize  your 
principles,  or  your  character,  or  your  conduct,  qualifications, 
temper,  etc.  The  very  best  of  men  are  sometimes  the  slowest 
to  make  friendly  overtures. 

There  is  a  very  great  difference  between  the  case  of  an  ad- 
ditional physician  starting  in  a  community  or  a  neighborhood, 
and  an  additional  perspn  being  added  in  almost  any  other  busi- 
ness. The  demand  for  other  things  can  be  increased,  but  the 
demand  for  physicians  is  limited  ;  so  that  a  new  physician  must 
create  his  practice  by  securing  this  patient,  then  that,  then 
another,  from  other  physicians.  Every  family  the  new  competitor 
adds  to  his  list  during  his  first  years  of  practice   must  leave  or 


HIS   REPUTATION   AND    SUCCESS.  31 

be  diverted  from  that  of  some  other,  who  may  have  attended 
it  long  enough  to  almost  deem  it  his  private  property ;  and, 
of  course,  the  loser  does  not  enjoy  the  loss  of  his  old  patients,  for 
there  is  a  little  of  the  old  Adam  and  love  of  monopoly  still  left 
in  a  man,  even  thougli  he  does  practice  medicine.  The  older 
practitioners  are,  therefore,  naturally  very  apt  to  feel  a  tinge  of 
jealousy,  and  to  be  watchful  of,  if  not  captious  toward,  Dr. 
Newcomer ;  and  when  they  see  him  crowding  himself  in,  inter- 
locking and  overlapping  them,  much  as  we  see  a  new  passenger 
push  into  an  already  crowded  street-car,  they  are  apt  to  look 
upon  him  as  a  presuming  antagonist  and  opponent,  and,  as  self- 
preservation  leads  every  man  to  prefer  himself  to  his  neighbor, 
unpleasant  animosities  and  feuds  are  apt  to  arise,  either  among 
those  who  are  well  disposed  or  otherwise.  Beware  of  these 
differences,  and  try  to  nip  them  in  the  bud. 

There  is  a  proverbial  rancor  and  bitterness  of  spirit  about 
medical  antagonisms  and  medical  hatreds,  some  of  which  termi- 
nate only  with  life ;  avoid  them  as  far  as  lies  in  your  power,  and 
endeavor  to  be  in  amicable  and  brotherly  relations  with  the 
physicians  of  your  neighborhood ;  and  should  you  ever  feel 
that  you  have  cause  for  complaint  against  a  brother  physician 
let  him  know  of  it,  and  give  him  an  opportunity  to  explain  and 
defend  his  action,  or  to  acknowledge  his  error,  if  he  is  in  error ; 
then,  if  you  disagree,  refer  the  case  to  mutual  professional 
friends  for  adjustment ;  or,  if  you  have  been  too  badly  treated  to 
admit  of  these,  you  may  feel  compelled  to  drop  intercourse  and 
pass  him  silently.  Remember,  however,  that  nothing  is  more 
disagreeable  than  to  have  enmity  and  a  rupture  of  intercourse 
with  those  we  must  often  face. 

It  is  natural  for  established  physicians  to  regret  the  advent 
of  another  medical  aspirant ;  and  some  are  suspicious,  cold, 
sensitive,  and  hypercritical  toward  every  new-comer;  because 
the  stranger,  in  coming,  must  exert  a  perturbing  effect  on  the 
professional  business  of  those  already  established.  His  coming 
makes  more   workers,  and,  if    he   is  skillful,  actually  makes 


32  THE   PHYSICIAN    HIMSELF: 

less  sickness,  because  the  spur  of  rivalry,  constant  and  sharp, 
stimulates  each  person  to  try  to  get  all  curable  cases  well,  not 
only  surely,  but  quickly.  Sickness,  both  in  amount  and  du- 
ration, is  decreased,  because  skilled  laborers  have  increased. 
There  is,  of  course,  no  greater  number  of  cracked  skulls,  man- 
gled limbs,  cut  fingers,  ague,  fits,  or  medical  cases  of  any  kind, 
than  before  Dr.  Last  came.  He  must,  therefore,  draw  his  share 
of  the  loaves  and  fishes  from  the  others. 

Read  how  eager  young  Absalom  was  to  push  old  David 
from  his  throne,  and  study  the  manoeuvres  of  that  ungrateful 
bird,  the  cuckoo  ;  how  the  fostered  cuckoo  hurls  all  the  other 
birds  from  their  maternal  nest  after  its  cunning  mother  has 
been  unwisely  allowed  to  deposit  an  egg,  and  their  parent  has 
watched  and  nourished  it  until  it  is  stronsr  enouoli  to  show  its 
ingratitude  by  hurling  the  rightful  owners  out,  and  you  will 
realize  why  Dr.  Elder,  Dr.  Bigbiz,  Dr.  Nopolizer,  Dr.  Duwell, 
Dr.  Kurumm,  and  other  old  and  prosperous  physicians  dislike 
to  see  new  Richmonds  gain  a  foothold  in  their  section,  and  un- 
der their  very  noses  effect  an  entrance  into  their  families.  Com- 
petitive practice  does  not  necessitate  jealousy  or  enmity ;  but 
self-preservation  is  the  first  law  of  nature,  implanted  by  the 
great  Creator  of  us  all ;  when  it  is  endangered,  every  human 
bosom  feels  the  same  impulse. 

Bear  in  mind,  honest,  conscientious,  courteous  rivalry  be- 
tween physicians  is  advantageous  to  the  public,  because  it  creates 
a  spirit  of  emulation  and  compels  each  to  try  to  be  skillful  and 
successful  in  practice ;  and  that  if  your  opponents  look  to  their 
own  good,  and  do  all  they  can  for  themselves  in  a  fair,  equitable, 
well-directed  manner,  you  have  no  right  to  complain. 

Your  first  efforts  in  practice  will  bring  you  into  contact  and 
contrast,  perhaps  also  into  collision,  with  the  other  practitioners 
of  your  vicinity,  and  then  you  can  each  learn  what  the  other  is. 

Be  not  boastful  or  intrusive,  but  if  you  are  conscious  of 
any  superior  aptitude  or  intellectual  power,  or  are  ahead  of  your 
brethren  in  any  essential  quality,  or  eclipse  them  in  talent  or 


HIS   REPUTATION   AND    SUCCESS.  33 

experience,  let  mere  matters  of  display  remain  secondary,  and 
depend  chiefly  on  your  solid  merit  for  success.  This  is  more 
durable,  less  expensive,  more  in  harmony  with  the  views  of 
sensible  people,  and  will  help  you  more  in  climbing  toward  the 
top,  and,  when  you  get  there,  will  be  the  surest  means  to  keep 
you  there. 

Every  one  on  the  face  of  the  globe  tries  to  be  wise  for  him- 
self, and  studies  his  own  interests,  and  desires  his  own  advance- 
ment; therefore,  do  not  hesitate  to  embrace  fully  every  accidental 
or  natural  advantage  of  birth  or  wealth,  or  the  favoritism  of 
influential  patrons  or  the  recommendation  of  powerful  friends, 
if  honest  and  ethical. 

You  will  find  that  intellect,  genius,  temperance,  correct 
personal  habits,  and  other  excellent  qualities  will  all  fail  to  make 
you  successful,  unless  you  add  ambition,  self-reliance,  and  aggres- 
siveness to  them  ;  but  in  your  eflbrts  to  advance  you  should  take 
care  not  to  incur  the  reputation  of  being  a  sharper  or  of  being 
tricky.  If  the  balance  were  struck,  it  would  probably  be  found 
a  great  deal  harder  for  a  physician  to  worm  and  intrigue  his 
way  through  life,  by  ingratiating  and  manoeuvring,  than  to 
struggle  along  with  honesty  and  industry.  Determine,  there- 
fore (under  God),  that  in  your  efforts  you  will  act  lilve  a  man, 
from  your  diploma  to  your  death-bed;  that  you  will  begin  well, 
continue  well,  and  end  well ;  and  will  do  nothing  that  is  criminal, 
nothing  that  will  not  stand  the  strongest  sunlight  and  the 
severest  scrutiny ;  nothing  for  which  you  would  hesitate  to  sue 
for  your  fee ;  and,  if  necessary,  to  stand  up  before  a  judge  and 
jury  to  claim  it;  nothing,  in  fact,  that  you  cannot  api)rove  of 
with  your  hand  on  your  heart  and  your  face  turned  upward. 


CHAPTER  IT. 

"Tie  who  does  the  best  his  circumstance  allows, 
Docs  well,  acts  uobly,  angels  could  do  no  more." 

There  has  been  of  late  years  a  large,  annual  addition  to 
our  already  overcrowded  profession,  and  the  doctor-making  col- 
leges of  tlie  United  States,  with  their  tempting  inducements  to 
students, — small  fees,  condensed  lectures,  quizzes,  "  loading  up  " 
at  the  licel  of  the  session  from  "compends,"  "epitomes,"  "vade 
mecums,"  and  "multum  in  parvo"  guide-books,  and  evenings 
at  grinding  clubs;  with  the  two  short  courses  of  lectures  required 
for  astonisldng  the  j)rofessors  in  the  green-room,  by  accurately 
repeating  the  majority  of  their  own  sapient  sayings,  and 
thereby  obtaining  the  M.D., — are  now  manufacturing  annually 
more  than  four  thousand  graduates,  besides  tlie  medical  im- 
migrants representing  all  nations  wlio  reach  our  shores  from 
abroad,  already  dubbed  M.D,,  and  prepared  to  enter  at  once 
upon  practice.  The  result  is  that,  if  it  requires  a  population  of 
1800  to  support  each  pliysician,  and  if  every  pliysician  must 
have  a  paying  clientage  of  1000  or  1200  persons  to  enable  him 
to  live  and  thrive,  there  are  now  in  every  American  community 
more  than  twice  as  many  physicians  as  are  required  by  the 
professional  work. 

Yea,  every  city,  town,  hamlet,  and  village,  every  cross-roads, 
every  nook  and  every  corner,  everywhere  in  our  land,  can  now 
boast  a  physician  or  two.  Canada  lias  but  one  for  every  1193 
inhabitants,  Austria  one  for  every  2500,  Germany  one  for  every 
3000,  Great  Britain  one  for  every  1652,  France  one  for  every 
1814,  Italy  one  for  every  3500,  while  we  of  the  United  States, 
blessed  C?;  in  pliysicians  as  in  everything  else,  have,  counting 
both  regulars  and  irregulars,  one  for  every  600,  and  druggists 
in  proportion.  If  there  were  only  a  few  more  than  needed  to 
fill  vacancies  caused  by  death  and  increase  of  population  it 
(34) 


HIS    REPUTATION   AND    SUCCESS.  35 

might  be  wholesome,  and  would  allow  the  public  a  choice,  but 
with  such  an  overproduction  as  this  there  is  not  professional 
work  enough  to  employ  all,  and  many  worthy  aspirants  must 
necessarily  languish,  and  those  who  do  flourish  must  do  so  by 
great  skill,  great  tact,  or  great  industry.  Another  result  of 
issuing  diplomas  so  freely  is  that  diplomas  aie  now  far  down 
in  public  estimation,  and  are  not  received  as  evidence  of  their 
owners'  competency  either  by  army  or  naval  examining  boards, 
or  even  by  State  licensing  boards. 

The  doors  to  the  ^sculapian  temple  are  open, — too  open 
to  every  variety  of  individual, — and  all  kinds  are  rusliing  in, 
and  you  will  be  unusually  lucky  if  you  encounter  none  who  are 
maliciously  antagonistic.  You  will  not  only  meet  Professor 
Loveall,  Dr.  Fair,  Dr.  Ettykett,  Dr.  Warmgrasp,  and  Dr.  Dove, 
but  Professor  Crank,  Dr.  Oblique,  Dr.  Sneerer,  Dr.  Crusty,  Dr. 
Quackit,  Dr.  Squabler,  Dr.  Frigid,  and  Dr.  Spitfire  are  also 
about,  and  may  be  encountered  in  unfriendly  collision. 

Bear  this  fact  in  mind,  and  avoid  all  manifestations,  and,  if 
possible,  all  feelings  of  petty  jealousy,  and  let  your  conduct  be 
affable  and  frank,  fair  and  square  to  everybody  on  all  occasions, 
and  strive,  in  your  daily  life,  to  build  a  reputation  for  profes- 
sional probity  that  will  excite  the  respect  of  all,  whether  friend 
or  foe,  and  convince  them  that  you  are  incapable  of  any  dis- 
honorable act. 

Avoid  all  quarrels,  bickerings,  and  disputes  with  your 
medical  brethren,  and  be  ever  ready  to  yield  a  point,  where  it 
involves  no  principle,  rather  than  engage  in  controversy  and  con- 
tention ;  and  if  ever  a  question  arises  between  you  and  a  brother 
physician  that  you  cannot  settle  yourselves  or  by  the  code  of 
ethics,  submit  it  to  the  decision  of  mutual  friends,  but  never 
begin  to  retaliate  or  make  reprisals,  and  avoid  all  innuendoes  and 
sarcastic  remarks  to  the  laity  about  opponents  who  have  offended 
you.  Exhibit  a  total  absence  of  professional  tricks,  and  resolve, 
once  for  all,  that  you  will  remain  and  act  as  a  gentleman,  even 
under  provocation,  wliethev  others  do  so  or  not.     Fail  not  to 


36  THE    PHYSICIAN    HIMSELF  I 

practice  the  golden  rule,  and  "  do  unto  others  as  you  would  have 
them  do  unto  you,"  and  trust  the  balance  to  time.  Medicine  is 
an  honorable  calling ;  resolve  that  it  shall  be  no  less  so  by  your 
adopting  it. 

Remember,  too,  that  honor  and  duty  require  you  to  do 
right  not  only  because  it  is  good  policy,  but  because  it  is  right. 
Do  not,  however,  be  so  trusting  as  to  "  look  for  wings  on  a 
wolf,"  or  expect  exact  justice  from  rivals  and  personal  enemies 
in  return ;  for,  were  you  as  chaste  as  Diana  and  as  pure  as 
the  falling  snow,  you  could  not  escape  misrepresentation  by  evil 
eyes,  wicked  hearts,  and  deceitful  tongues. 

Like  every  other  physician,  you  will  have  your  friends  to 
extol  you  and  your  enemies  to  condemn  and  decry  you,  and 
althougli  you  can  neither  stop  the  latters'  tongues  nor  prevent 
all  unfavorable  public  criticism,  yet  you  must  take  care  that 
nothing  be  permitted  to  blast  your  reputation  for  upright,  honor- 
able conduct.  Charges  against  your  skill,  unless  very  gross  and 
damaging,  had  better  be  left  unnoticed,  or  passed  over  with  in- 
difference; even  though  it  reaches  your  ears  that  some  Little- 
wit,  or  Grundy,  or  Glibtongue  has  said  he  has  a  total  lack  of 
faith  in  you,  and  would  not  call  you  to  attend  his  ailing  cat  or 
dog,  such  sarcasm  need  not  disturb  your  equanimity,  nor  be 
taken  as  personal;  remember  that  such  remarks  are  simply  indi- 
vidual expressions  of  lack  of  faith  in  you  professionally.  Such 
things  are  said  about  every  physician  in  the  world,  and,  although 
they  grate  harshly  when  they  reach  the  ear  of  him  to  whom 
they  apply,  they  are  quite  different  from  personal  libels,  or  such 
as  bring  your  morals  or  integrity  into  question, — charges  of 
being  a  swindler,  or  a  drunkard,  or  an  adulterer,  or  a  seducer,  or 
a  murderer,  or  an  abortionist,  for  example. 

Never  boast  of  the  number  of  cases  you  have ;  of  your 
remedies,  operations,  and  wonderful  cures  ;  or  of  the  surprisingly 
large  amounts  of  your  collections.  All  such  things  are  apt  to 
create  envy,  jealousy,  disbelief,  adverse  criticism  (Professor 
Pufliimself  or   Dr.    Hornblower),  and    other   hurtful    results. 


HIS   REPUTATION    AND    SUCCESS.  37 

Also  avoid  talking  about  yourself,  or  telling  from  house  to  house 
how  terribly  busy  you  are,  and  of  your  numerous  bad  cases, 
and  claiming  to  save  the  lives  of  all  wlio  do  not  die.  Indeed, 
it  is  better  to  say  but  little  in  regard  to  your  own  merits,  either 
in  the  way  of  exaggeration  or  depreciation,  and  to  relate  noth- 
ing at  all  to  laymen  about  any  case  but  the  one  before  you  ; 
phthoothorn  bragging  will  not  enhance  your  merits  with  sensible 
people,  and  if  you  really  have  extra  cases  and  extra  skill,  or  are 
a  great  anatomist  or  eminent  surgeon,  people  will  be  sure  to  find 
it  out  in  other  ways.  Also  keep  your  business  affairs  and  your 
money  matters  to  yourself,  and  avoid  the  habit  of  talking  to  people 
about  your  collections,  bills,  etc.,  unless  it  be  to  a  person  about 
his  own  bill,  or  you  will  soon  get  the  reputation  of  thinking  and 
talking  more  about  money  matters  than  anything  else. 

As  a  physician,  you  will  require  a  good  address  and  varied 
talents,  for  you  must  come  in  contact  with  all  kinds  of  people. 
An  intelligent  readiness  in  adapting  yourself  to  all  classes  suffi- 
ciently for  the  requirements  of  your  profession  is  an  iuA'aluable 
faculty,  and  one  in  which  most  physicians  are  sadly  deficient. 

In  addition  to  professional  knowledge,  you  should  make 
yourself  fairly  conversant  with  general  scientific  subjects  that 
tend  to  exercise  the  reason  rather  than  the  memory,  and  also 
with  general  and  polite  literature,  that  you  may  acquire  ideas, 
a  nice  discrimination  of  words,  and  improved  power  and  facility 
of  expression,  and  so  put  yourself  on  a  conversational  level  with 
the  cultured  classes  with  whom  you  are  likely  to  be  brouglit 
into  contact.  In  fact,  among  intellectual  and  educated  people, 
good  conversational  powers  and  broad  culture  often  actually 
})roduce  a  higher  opinion  of  a  physician's  professional  ability 
than  is  really  possessed.     Besides, 

"Wisdom  is  the  sunlight  of  the  soul," 

and  there  is  a  perpetual  delight  in  the  possession  of  knowledge. 
Therefore,  keep  your  dictionaries  and  encyclopsedias  at  your 
elbow  ;  patronize  them  freely,  and,  when  your  reading  or  musing 
excites    your   curiosity  on  any  subject,  turn  to   them   and   be 


38  THE   PHYSICIAN    HIMSELF  I 

informed.  They  are  very  convenient  and  useful  in  looking  up 
iacts  and  opinions  when  you  have  hut  a  few  moments  to  devote 
to  an  inquiry. 

"We  live  in  thoughts,  not  breaths. 
He  most  lives  who  thinks  most." 

One  who  can  neither  conjugate  amo  nor  decline  penna  may 
reduce  a  dislocation,  adjust  a  fracture,  tie  an  artery,  or  prescribe 
a  drug  as  skillfully  as  the  Latinist  can ;  yet  a  good  (classical) 
education,  and  the  mental  images,  ideas  and  discipline  that  fol- 
low, although  not  indispensably  necessary  to  the  acquirement 
of  skill,  experience,  and  success  as  a  physician,  are  powerful 
elements  in  the  professional  struggle.  Therefore,  if  you  have 
begun  late  in  life,  and  are  defective  in  early  training,  be  not  cast 
down  ;  but,  to  rid  yourself  of  the  charge  of  illiteracy  and  misap- 
plication of  words,  make  up  the  deficiency  by  dint  of  study 
and  self-education,  as  fully  as  possible ;  otherwise,  it  will  make 
you  ashamed  of  your  want  of  knowledge,  and  either  keep  you 
hid  among  the  nonentities  of  the  profession  or  perpetually  debar 
you  from  obtaining  more  than  a  limited  elevation  in  it. 

Indeed,  without  educational  and  other  qualifications  you 
can  no  more  enjoy  social  or  professional  rank,  or  reach  true 
eminence,  than  a  pigeon  can  fly  upward  with  but  one  wing. 
The  true  secret  is  to  be  qualified  for  advancement ;  besides, 
without  a  fair  education  you  will  be  continually  exposed  to 
ridicule  for  your  ignorance  or  vulgarism  by  persons  who  are, 
perhaps,  very  much  your  inferiors  in  those  peculiar  gifts  of 
heaven, — genius  and  sound  common  sense.  But  while  a  phy- 
sician cannot  know  too  mucli,  I  strongly  doubt  the  wisdom  of 
frittering  away,  after  practice  is  begun,  a  disproportionate 
amount  of  time  on  educational  frivolities  and  school-boy  sub- 
jects, or  giving  them  more  time  than  recreative  attention  allows. 
Nor  is  it  wise  to  give  special  attention  to  higher  mathematics, 
the  fine  arts,  the  great  classics,  zoology,  comparative  anatomy, 
mineralogy,  botany,  Egyptology,  geology,  conchology,  or  other 
collateral  studies,  while  yet  imperfect  in  the  practical  and  essen- 


HIS   REPUTATION    AND    SUCCESS.  39 

tial  principles  of  medicine,  because  simultaneous  attention  to 
multifarious  subjects  prevents  concentration  of  thoughts,  and 
naturally  divides  and  distracts  one's  mind,  and  prevents  one 
from  pursuing  the  strictly  needful  studies  with  his  full  strength. 
Do  not  attempt  to  grasp  more  than  you  can  hold,  but  pursue 
whatever  you  do  undertake  with  manly  determination  and 
continuity  of  effort. 

The  plan  of  forcing  themselves  tenaciously  to  pursue  aims 
of  a  practical  character  constitutes  the  peculiarity  of  most  men 
who  rise  much  above  the  ordinary  level  and  succeed  in  an 
eminent  degree.  This  is  not  only  true  in  medicine,  but  in  any 
calling.  1  once  knew  a  person  who  by  accident  lost  his  leg 
at  the  middle  of  the  thigh ;  previous  to  this  he  was  but  an 
ordinary  swimmer,  but  afterward  the  fact  of  his  having  only 
one  leg  attracted  special  attention  to  his  swimming.  Seeing 
himself  thus  observed  stimulated  him  continually  to  do  his  best, 
which  made  him  more  and  more  expert,  until  eventually  he 
became  the  best  swimmer  I  ever  saw,  because  the  most  ambitious. 

A  knowledge  of  Latin  to  even  a  limited  extent  is  of  ines- 
timable value.  If  you  are  not  a  scholar,  and  have  not  had  the 
advantage  of  embracing  it  in  your  early  education,  you  should 
not  fail  to  employ  some  Latin  scholar  to  teach  you  at  least  as 
much  as  you  need  in  your  practice ;  you  can  get  one  at  small 
cost  by  advertising  anonymously  in  any  daily  paper.  He  can, 
with  the  aid  of  a  Latin  grammer  (Gildersleve's  Latin  primer  is 
excellent)  and  a  dictionary,  teach  you  in  a  short  time  sufficient 
of  the  outlines  of  the  Latin  language  to  enable  you  to  understand 
the  etymological  import  and  pronunciation  of  words,  phrases, 
and  technical  terms,  and  to  write  prescriptions,  etc.,  correctly, 
and  thereby  lift  you  above  a  feeling  of  abashment  at  your  de- 
ficiency in  this  obviously  important  particular,  give  a  constant 
sense  of  security,  and  afford  perpetual  satisfaction.  No  matter 
where  you  get  your  Latin,  so  you  get  it  somewhere.  Ability  to 
write  prescriptions  in  correct  Latin,  also,  naturally  assists  in 
creating  respect,  or,  rather,  in  preventing  unfriendly  criticism 


40  THE   PHYSICIAN    HIMSELF  I 

and  disrespect,  in  the  minds  of  your  fellow-physicians,  the  drug- 
gists, and  others.  Besides,  all  laymen  suppose  that  every  phy- 
sician understands  some  Latin,  and  if  they  find  him  ignorant  of 
this  they  naturally  think  him  equally  so  in  everything  else. 

Many  people  really  believe  we  write  prescriptions  in  Latin 
in  order  to  mask  their  ingredients.  The  true  intent,  however, 
is  to  give  every  article  (and  every  quantity)  a  concise  and  specific 
title,  and  to  point  it  out  in  such  a  manner  that  when  we  call  for 
it  in  a  prescription  we  may  get  it,  and  nothing  else,  thus  making 
mistakes  of  meaning  between  the  prescriber  and  the  compounder 
impossible ;  besides,  the  Latin  names  of  drugs  are  the  same  in 
America,  Europe,  and  elsewhere,  and  can  be  read  by  the  scholars 
of  all  nations,  while  the  common  names,  sugar  of  lead,  lauda- 
num, black  wash,  etc.,  are  liable  to  differ  with  each  nation  and 
locality.  Thus,  aqua  is  water  in  Baltimore,  and  is  the  same  in 
Paris,  in  Calcutta,  and  in  St.  Petersburg.  Latin  is  a  dead  lan- 
guage, belonging  to  no  modern  nation,  and  therefore  fixed,  and 
not  subject  to  mutations.  It  is  not  only  perfectly  accurate,  but, 
by  long  usage,  is  in  high  repute. 

A  rudimentary  knowledge  of  Greek  is  also  useful,  as  from 
it  have  been  formed  three-fourths  of  the  compound  terms  em- 
ployed in  the  medical  and  other  sciences.  Indeed,  Latin  and 
Greek  have  furnished  the  materials  for  building  up  the  lan- 
fifuaofe  of  the  various  sciences  for  more  than  two  thousand  years. 
The  meaning  of  the  terms  semi-lunar  and  dys-uria  are  as  plain 
and  descriptive  to  those  who  understand  Latin  and  Greek  as 
the  words  milk-pail  and  steam-boat  are  to  those  who  understand 
English. 

In  using  the  Latin  names  of  medicines,  diseases,  muscles, 
etc.,  be  consistent.  Adopt  either  the  broad  English  or  the 
(Roman)  Continental  pronunciation,  but,  whichever  you  adopt, 
be  careful  to  use  it  invariably  and  correctly.  You  may  acquire 
a  correct  pronunciation  of  the  various  medical  terms  by  fre- 
quently consulting  a  dictionary,  of  which  there  is  none  better 
than  Dunglison's  latest  etUtion. 


HIS   REPUTATION    AND    SUCCESS.  41 

German  is  another  of  tlie  world's  great  languages,  and  an 
acquaintance  with  it  is  not  only  pleasurable  and  a  means  of  in- 
tellectual improvement  that  costs  but  little  money,  but  it  will 
assist  you  greatly  with  the  industrious,  faithful,  and  thrifty 
Germans,  among  whom  you  will  find  many  of  your  most  honest 
and  grateful  patients.  Determine  to  get  at  least  a  smattering 
of  it  early  in  your  career.  If  you  speak  German,  it  is  well  to 
mention  the  fact  on  your  cards. 

Remember  that  no  one  can  learn  to  speak  the  German  or 
any  other  language  unless  conversation  enters  largely  into  his 
teaching ;  he  must  learn  it  through  his  ears,  as  well  as  through 
his  eyes. 

You  will  find  that  many  foreigners  prefer  an  American 
physician  who  can  speak  their  language  to  one  who  has  come 
here  from  their  own  country,  and  have  more  confidence  in  him, 
because,  being  a  native,  they  know  he  has  spent  his  whole  life- 
time here,  and  they  reason  that,  although  the  great  principles 
of  medicine  may  be  taught  and  learned  anywhere,  he  is  by  ex- 
perience more  familiar  with  the  diseases  that  exist  in  our 
climate,  the  peculiarities  of  the  vicinity,  and  the  modifying  in- 
fluences of  our  seasons,  diet,  and  modes  of  living. 

A  German,  Frenchman,  Spaniard,  Italian,  or  Bohemian 
will  often  be  delighted  to  find  a  physician  in  an  English-speak- 
ing community  with  whom  he  can  converse  in  his  own  tongue. 
Foreigners  often  pay  much  more  liberally  than  natives,  and 
usually  treat  the  physician  with  much  greater  respect. 

A  physician  is  at  perfect  liberty  to  state  on  his  cards  and 
signs  that  he  speaks  French,  Italian,  Spanish,  Bohemian,  Ger- 
man, or  any  other  foreign  language ;  and  such  a  statement 
should,  if  made,  be  in  the  language  of  the  people  for  whom  it  is 
intended. 

Accustom  yourself  to  use  current  and  correct  orthography, 
and  to  write,  not  with  a  scrawling  hand,  in  a  zigzag  or  the 
worm-fence  style,  but  in  a  good,  neat,  distinct,  school-day  hand. 
Write  every  prescription  as  though  critics  were  to  judge  you 


42  THE    PHYSICIAN    HIMSELF: 

and  your  penmanship  by  it ;  each  ingredient  on  a  separate  line, 
the  principal  article,  or  the  strongest  drug  on  the  first,  adjunct  on 
the  next,  and  veliicle  on  the  last,  unless  you  have  some  special 
reason  for  inverting  them.  Such  methodical  system  msures 
well-halanced  prescriptions,  and  engenders  the  respect  and  favor- 
able criticism  of  those  into  whose  hands  they  chance  to  fall. 
Also,  take  care  to  conform  your  prescriptions  to  the  changes  that 
are  from  time  to  time  made  in  the  names  of  the  officinal  articles 
of  the  pharmacopoeia  by  authorized  bodies  and  nomenclators. 

Strictly  avoid  prescribing  incompatibles,  both  chemical  and 
physiological,  such  as  the  combination  of  chlorate  of  potassium 
with  tannic  acid  or  with  sulphur,  nitrate  of  silver  with  creasote, 
etc.,  which  are  explosives,  and  may  blow  up  either  the  dispenser  or 
the  patient.  Cliarcoal  is  a  simple  thing,  sulphur  is  another, 
and  saltpetre  is  still  another,  but  put  them  together  and  you 
have  gunpowder,  which  is  not  simple,  and,  unless  that  potent 
agent  is  intended,  look  out.  Although  the  list  of  incompatibles 
is  a  long  one,  you  will  do  well  to  learn  it  thoroughly,  otherwise 
you  will  subject  yourself  to  the  sarcastic  remarks  of  the  pliar- 
macist,  and  possibly  to  whispering  doubts  and  disparaging  innu- 
endoes. Remember,  however,  that  some  medicines,  though 
physiologically  incompatible,  are  not  therapeutically  so,  as 
under  certain  circumstances  you  may  combine  them  so  that 
they  may  favorably  modify  each  other,  as  morphia  and  belladonna, 
acetate  of  lead  and  sulpliate  of  zinc,  etc. 

Instead  of  writing  prescriptions  three  inches  in  length,  it  is 
better  to  use  a  single  remedy,  or,  if  two  are  indicated,  to  alter- 
nate them,  unless  you  know  they  are  compatible  and  will  not 
make  an  unsightly  mixture. 

Again,  your  prescription  is  always  the  expression  of  your 
opinion  and  of  your  skill  in  a  case  : — 

"The  mind  is  the  man." 

Therefore,  try  to  make  every  one  you  write  show  on  its  face  that 
you  have  prescribed  with  a  definite  purpose,  to  meet  some  clear 
indication. 


HIS   REPUTATION   AND    SUCCESS.  43 

Be  careful  that  abbreviations  of  names,  manner  of  writing 
quantities,  etc.,  leave  no  room  for  mistake  or  inexactness  in  dis- 
pensing, and  make  it  a  rule  to  read  carefully  every  prescription 
after  you  finish  writing  it. 

It  is  scarcely  necessary  to  add  that,  while  the  distinctive 
names  of  the  several  ingredients  in  a  prescription  sliould  be 
written  in  Latin,  the  directions  for  use,  i.e.^  all  that  follows  the 
S.  (signa),  should  be  in  English,  as  they  are  intended  for  the 
guidance  of  the  patient. 

Remember  that  the  cloven-foot  I^,  that  is  placed  at  the 
head  of  every  prescription  (prse,  beforehand ;  scriba,  to  write), 
although  originally  the  astrological  sign  for  Jupiter  (1/),  and 
for  ages  placed  by  the  ancients  at  the  head  of  prescriptions,  to 
invoke  the  aid  of  the  God  of  Thunder,  is  now  used  merely  as  a 
symbol  to  represent  the  Latin  word  Recipe  (take  thou). 

While  it  is  proper,  strictly  speaking,  to  commence  every 
word,  after  the  first,  in  the  names  of  the  articles  in  your  pre- 
scription with  a  small  letter,  i.e..  Liquor  potassii  arsenitis,  yet 
many  physicians  purposely  begin  each  with  a  capital,  chiefly 
because  it  looks  well,  and  also  renders  the  word  less  mistakable. 

Sign  either  your  name  or  initials  to  every  prescription  you 
write,  that  the  pharmacist  may  recognize  its  writer ;  to  such  as 
are  likely  to  be  compounded  by  pharmacists  who  know  you  well 
the  initials  will  be  sufficient,  but,  to  all  that  are  likely  to  be  put 
up  by  those  who  know  you  not,  put  your  full  name. 

Li  prescribing,  it  is  a  bad  and  injudicious  habit  to  adopt  a 
routine  practice,  or  slavishly  to  follow  your  own,  or  anybody 
else's,  stereotyped  formulae  for  certain  diseases.  You  should 
invariably  adapt  your  remedies  to  the  case,  instead  of  heedlessly 
picking  out  a  ready-made  formula  from  your  collection  as  you 
would  a  hat  in  a  hat-store.  One  formula,  for  instance,  for  the 
several  forms  of  diarrhoea,  is  about  as  apt  to  suit  every  case  of 
relaxed  bowels  as  one  coat  is  to  fit  every  man  in  a  regiment. 

Remember  that  medicine  is  a  mass  of  facts,  and  that  he 
who  best  interprets  these  facts  is  the  best  physician,  and  that 


44  THE   PHYSICIAN    HIMSELF  I 

skill  in  practice  consists  not  only  in  diagnosis,  prognosis,  and 
prescribing  medicine,  and  in  knowing  what  one  can  and  what 
one  cannot  do,  bnt  is  the  combined  resnlt  of  all  the  powers  that 
the  physician  legitimately  brings  into  the  management  of  cases. 
In  other  words,  the  skillful  use  of  drugs  is  but  one  of  many  ele- 
ments that  make  the  unit  of  medical  skill.  You  must  also  study 
mankind  as  well  as  medicine,  and  remember,  when  w^orking  on 
diseased  bodies,  that  they  are  inhabited  by  minds  that  have  vari- 
able emotions,  strong  passions,  and  vivid  imaginations,  which 
sway  them  powerfully,  both  in  health  and  in  disease.  To  be 
successful  you  should  fathom  each  patient's  mind,  discover  its 
peculiarities,  and  conduct  your  efforts  in  harmony  wdth  its  con- 
ditions. Let  hope,  expectation,  faith,  contentment,  fear,  resolu- 
tion, will,  and  other  psychological  states  be  your  constant  aids, 
for  they  may  each  at  times  exercise  legitimate  power,  and  impart 
the  greatest  amount  of  good  to  the  sick.  It  is  not  length  of 
time  in  practice,  but  observation  and  reflection,  that  teach  one 
to  measure  human  passions  and  emotions ;  and  if  you  are  not  a 
keen  observer  of  men  and  things,  if  you  cannot  read  the  book 
of  human  nature  correctly,  and  unite  knowledge  of  physic  with 
an  understanding  of  the  effects  of  love,  fear,  grief,  anger,  malice, 
envy,  lust,  and  other  hidden  but  strong  passions  that  govern 
our  race,  you  will  be  sadly  deficient  even  after  twenty  years' 
experience : — 

"Hair  gray,  and  no  brains  yet." 

Professional  fame  is  a  physician's  chief  capital ;  ambition 
to  increase  it  by  all  legitimate  means  is  not  only  fair,  but  com- 
mendable. After  you  attain  this,  you  will  not  be  apt  to  lose 
either  it  or  the  practice  it  insures,  so  long  as  you  are  sober, 
decent,  and  discreet  in  conduct,  and  have  the  physical  health 
to  endure  the  watching,  fatigue,  and  exposure  incident  to  our 
business. 

There  are  two  kinds  of  legitimate  reputation  a  physician 
may  acquire, — a  popular  or  common  one  with  the  people,  and 
a  higher  professional  one  with  his  brethren.     These  are  often 


HIS   REPUTATION   AND    SUCCESS.  45 

based  on  entirely  different  grounds,  and  are  usually  no  measure 
of  each  other ;  a  few  of  the  most  excellent,  with  loftier  ambition, 
struggle  earnestly  for  the  latter,  Avhile  the  mass  are  striving 
for  the  former,  chiefly  because,  being  altogether  practical,  it 
requires  less  skill,  talent,  and  study  to  acquire,  and,  also,  because 
it  is  more  profitable.  Many  such  avoid  all  great  scientific 
labors  and  controversies,  and,  having  little  or  no  public  life, 
remain  shut  up  within  themselves,  moving  about  quietly  and 
almost  unobserved  except  by  those  whom  they  attend ;  conse- 
quently, a  knowledge  of  their  habits  and  doings  is  confined  to 
the  domestic  bedside  and  the  narrow  circle  of  their  private  prac- 
tice, and  the  degree  of  their  skill  and  experience  always  remains 
somewhat  unknown  and  mysterious. 

Without  one  or  the  other  variety  of  reputation  no  phy- 
sician can  reap  the  honors  or  rewards  which  are  the  objects  of 
his  ambition,  whether  that  be  the  acquisition  of  money,  the 
desire  of  usefulness,  or  the  love  of  fame.  You  should  strive  to 
acquire  both  varieties. 

One  fact  that  you  will  notice  is,  that  the  public  naturally 
prefer  a  full-of-health,  ever-ready  physician  to  a  delicate  or 
sickly  one,  and  ailing  physicians  often  conceal  the  fact  that 
they  are  sickly  or  that  their  health  is  failing  as  much  and  as 
long  as  possible,  well  knowing  that  the  competition  in  our  pro- 
fession is  now  so  great  that  for  every  person  whose  powers  fail 
ten  are  ready,  with  fresh  strength,  to  take  his  place,  and  that, 
if  reports  of  their  ailments  become  current  talk,  the  public  will 
believe  that  solicitude  for  their  own  condition  will  absorb  it 
from  their  patients,  and  they  will  be  abandoned  as  unrehable 
and  unfit  to  practice,  and  their  business  will  be  thereby  injured 
or  ruined. 

After  you  have  practiced  awhile  and  discovered  what  your 
chief  deficiencies  are,  and  determine  exactly  what  course  you 
ought  to  pursue,  if  you  will  spend  a  few  months  in  additional 
study  of  the  great  prhiciples  of  our  science  in  some  of  the 
great  American  or    European  hospitals,  and  then  return  and 


46  THE   PHYSICIAN    HIMSELF  I 

settle  down,  it  will  be  of  tenfold  benefit  to  you  in  more  ways 
than  one. 

A  discreet  tongue  is  a  great  gift  and  a  great  aid  to  success. 
When  elopements,  seductions,  rapes,  confinements,  or  abortions ; 
or  the  scandal  about  Dr.  Bigscamp,  or  Rev.  Mr.  Blacksheep,  or 
Miss  Oilyeve,  or  the  ignobleness  of  tlie  pedigree  of  Mrs.  But- 
terfly, or  the  secret  history  of  Miss  Pride,  or  the  wrecked  and 
wretched  greatness  of  Mr.  Pomp,  or  the  adulteries  or  intrigues 
of  Mrs.  Freelove,  or  the  evil  reports  about  this  virgin,  that  wife, 
or  the  other  widow,  are  being  talked  of,  perhaps  in  terms  that 
decency  would  require  to  be  printed  only  witli  initial  and 
terminal  letters,  with  a  dash  between,  you  should  have  a  silent, 
or  at  least  a  prudent,  tongue  ;  all  you  say  on  such  subjects  will 
surely  be  magnified  and  repeated  from  mouth  to  mouth,  and  its 
results  will  be  a  permanent  injury  to  you.  The  position  of  the 
gossiping  physician  has  ever  been  a  very  bad  one,  and  he  is 
sometimes  called  to  unpleasant  account. 

Take  especial  care,  while  in  contact  with  tale-bearers  and 
scandal-mongers,  or  scandal-loving  crowds,  to  keep  the  conver- 
sation on  general  or  abstract  and  legitimate  subjects,  and  deter- 
minedly avoid  descanting  upon  hidividuals  and  private  affairs, 
or  what  somebody,  or  a  coterie  or  clique  of  somebodies,  has 
said. 

Be  careful,  also,  to  note  tlie  great  and  never-failing  advan- 
tage that  refined  people,  with  virtuous  minds,  pure  thoughts, 
and  courteous  language,  have,  in  every  station  of  life,  over  the 
coarse  and  the  vulgar ;  and  in  view  thereof  let  your  manner, 
conversation,  jokes,  etc.,  be  always  chaste  and  pure.  Never 
forget  yourself  in  this  particular,  for  nothing  is  more  hurtful  to 
a  physician  than  the  exhibition  of  an  impure  mind.  School 
yourself  to  avoid  all  and  every  impropriety  of  language  and 
manner,  and  never  allow  yourself  to  become  insensible  to  the 
demands  of  modesty  and  virtue.  Chasten  every  thought, 
weigh  well  every  word,  and  measure  every  phase  of  your 
deportment, — especially  that  which  concerns  the  fair  fame  of 


HIS   REPUTATION    AND    SUCCESS.  47 

woman, — and  let  your  treatment  of  all  females  be  refined  and 
delicate,  if  you  would  succeed  fully,  especially  if  gynaecology 
and  obstetrics  be  the  one  great  aim  of  your  ambition.  A  lewd- 
minded  physician  who  indulges  in  double  eutendres,  coarse 
ambiguities,  vulgar  jokes,  jocular  innuendoes,  and  indelicate 
anecdotes  about  the  sexes — 

"To  reflect  on  women  ever  ready" — 

with  other  men  or  with  coarse  women,  even  though  he  pcses  as 
a  gentleman,  is  sure  to  be  shunned,  and  the  reason  therefor  made 
the  subject  of  gossip  and  passed  from  one  to  another  in  social 
whispers,  till  it  reaches  the  purest  and  best  of  the  community. 
Thoughtful  people  of  both  sexes  everywhere  rightfully  regard 
such  libertines  as  being  far  more  amenable  to  criticism,  and  far 
more  dangerous  to  admit  into  the  bosoms  of  their  famihes,  than 
rough-mannered  believers  in  social  purity  who  gamble,  drink, 
or  swear. 

'-Immodest  words  admit  of  no  defense, 
For  want  of  decency  is  want  of  sense." 

Study  the  art  of  questioning,  and  when  it  devolves  on  you, 
in  the  course  of  professional  duty,  to  ask  questions  on  delicate 
topics,  or  to  broach  very  private  subjects,  do  so  with  a  chaste, 
grave  simplicity,— neither  too  direct  on  the  one  hand,  nor  with 
too  much  circumlocution  on  the  other. 

Physicians  are  made  in  the  colleges,  but  tried  in  the  world. 
Your  personality  and  deportment  in  the  presence  of  patients 
will  have  much  to  do  with  your  success.  Blessed  is  the  phy- 
sician who  has  the  gift  of  making  friends.  A  pompous,  or  cold, 
or  cheerless,  heartless  or  indifferent  manner  toward  peo[)le;  or 
a  studied  or  sanctimonious  isolation  of  one's  self  from  them 
socially ;  or  failure  to  recognize  would-be  friends  on  the  streets 
and  elsewhere,  as  if  from  a  lofty  independence,  or  as  if  they 
were  inferior  mortals  and  beneath  you, — 

"I  am  resolved  on  death  or  dignity," — 

oflen  gives  unmeant  offense,  and  tends  to  destroy  all  warmth 
toward  a  physician,  and  usually  causes  their  hapless  possessor 


48  THE    PHYSICIAN    HIMSELF: 

to  fail  to  inspire  either  friendly  partiality  or  faith ;  and  a  phy- 
sician who  cannot  in  some  way  make  friends  or  awaken  faith  in 
himself  cannot  fail  to  fail.  The  reputation  of  being  a  "  very 
nice  man  "  makes  friends  of  everybody,  and  is,  with  many,  even 
more  potent  than  skill.  To  be  both  affable  in  manner  and  skill- 
ful in  action  makes  a  very  strong  combination, — one  that  is  apt 
to  waft  its  possessor  up  to  the  top  wave  of  professional  success 
and  repute.  If,  moreover,  he  be  especially  refined  in  manner 
and  moderately  well  versed  in  medicine,  his  politeness  will  make 
him  a  troop  of  friends,  and  will  be  professionally  more  effective 
with  them  than  the  most  profound  acquaintance  with  histology, 
microscopic  pathology,  and  other  scientific  acquirements. 

If  your  manners  and  conversation  are  of  the  gentle,  soft, 
and  tender  kind,  that  win  and  conciliate  rather  than  repel  chil- 
dren, it  will  be  fortunate,  and  probably  will  put  many  a  dollar 
into  your  pocket  that  might  have  gone  to  some  irregular.  Such 
habits  as  fondling  and  kissing  people's  teetsy-weetsy  children, 
or  carrying  them  pockets  of  candy,  however,  are  liable  to  be 
misconstrued  into  an  effort  to  secure  the  good  will  of  the  parents 
for  selfish  motives,  and  should  therefore  be  avoided. 

Cultivate  a  cheerful  mental  temperament ;  gentle  cheer- 
fulness is  a  never-failing  source  of  influence.  It  is  a  magnetic 
nerve  tonic  and  stimulant ;  it  diffuses  sunshine,  cheers  the  tim- 
orous, dispels  the  deadening  fogs  of  hopelessness,  encourages  the 
despondent  to  look  on  the  bright  side,  and  comforts  the  despair- 
ing. The  science  of  medicine,  contrary  to  the  general  belief,  is 
not  a  melancholy,  sombre,  mournful  profession,  but  a  bright, 
cheerful  one.  The  sincerely  grateful  faces  you  will  see  and  the 
"Thanks  to  God!"  you  will  hear  while  completely  curing  some 
poor  fellow-creatures  and  relieving  others  of  pain  and  ailments, 
and  allaying  fear  and  administering  comfort  to  the  minds  of 
multitudes  of  others,  will  make  you  realize  your  usefulness  and 
the  great  good  your  noble,  humane,  and  beneficent  profession 
enables  you  to  confer  on  suffering  humanity, — the  contemplation 
of  which  should  make  you  cheerful  and  happy,  and  satisfied 


HIS   REPUTATION    AND    SUCCESS.  49 

with  yourself  and  your  elected  life-work,  in  spite  of  the  many  con- 
tradictions and  disappointments  you  are  subject  to  in  practice. 

Bear  in  mind  that  the  physician's  visit,  being  the  chief  event 
of  a  sick  person's  day,  is  eagerly  watched  for,  and  let  no  ordinary 
engagements  interfere  with  your  punctuality  in  making  it; 
also  study  to  acquire  an  agreeable,  courteous,  gentlemanly, 
and  professional  manner  of  approaching  the  sick  and  taking 
leave  of  them.  There  is  an  art,  a  perfection,  in  entering  the 
chamber  of  sickness  with  a  dignified  yet  gentle  manner,  that 
clearly  evinces  interest  and  a  determination  to  master  the  case, — 
in  asking  the  necessary  questions,  in  making  the  requisite  ex- 
amination, then  carefully  and  wisely  ordering  the  proper  reme- 
dies, and  departing  with  a  cheerful,  self-satisfied  demeanor  that 
puts  the  patient  at  his  ease,  and  inspires  confidence  on  the  part 
of  himself  and  his  friends,  and  a  belief  that  you  can  and  will 
do  for  him  all  that  the  science  of  medicine  enables  you  to  do. 
The  personal  appearance,  the  walk,  the  movements,  the  gestures, 
the  polite  bow,  the  well-modulated  voice,  the  language,  the 
natural  mode  of  intercourse,  and  the  elegant  and  instructive 
conversation  of  some  physicians  are  as  cheering  and  confidence- 
inspiring,  to  the  sensitive  nerves  of  the  sick,  as  a  sunbeam  on  a 
May  day  ;  the  manners  of  others,  as  rude,  coarse,  cold,  heartless, 
indifferent,  and  repulsive  as  a  March  wind. 

Familiarity  with  the  many  little  details  of  the  sick-room — 
including  the  necessary  art  of  applying  bandages,  making  beef- 
teas,  gruels,  mustard  plasters,  poultices,  etc.,  and  with  dressing 
wounds,  passing  catheters,  reducing  herniae  ;  getting  a  fish-bone 
from  the  throat,  a  splinter  or  a  needle  from  the  hand,  or  a  mote 
from  the  eye,  or  teaching  the  nurse  how  to  prepare  the  obstetric 
bed ;  seeing  that  those  working  subordinate  to  you  do  their 
duty,  and  various  other  minor  duties  that  you  may  be  there 
incidentally  called  on  to  perform  or  direct — often  do  more  to 
create  a  favorable  impression  than  your  pills  and  powders.  In- 
deed, it  is  to  a  very  great  extent  by  minor  matters  that  watchful 
nurses  and  other  habitues  of  the  sick-room  will  judge  you. 


50  THE   PHYSICIAN    HIMSELF: 

As  a  physician  you  should  be  hopeful,  and  not  indiscreetly 
abandon  cases  usually  considered  hopeless.  Hope  creates  ideas, 
generates  new  expedients,  brings  up  useful  reflection,  and  leads 
to  fresh  endeavors.  Indeed,  it  has  been  said  that  the  only  way 
to  get  cured,  and  render  impossibility  possible,  after  a  physician 
loses  hope  and  gives  you  up,  is  to  give  him  up. 

The  faculty  of  keeping  hope  and  confidence  alive  in  tlie 
bosom  of  the  patient  and  of  his  friends  is  a  great  one,  and  the 
look  with  which  you  meet  them  has  much  to  do  with  this ;  a 
bright,  fresh,  thoughtful  countenance,  and  an  easy,  cheerful, 
soothing,  professional  air  and  manner  are  powers  that  will  well- 
nigh  always  impart  tranquillity  and  repose  to  your  patient's 
mind  and  carry  him  with  you  toward  recovery.  A  cheering 
word  sometimes  rekindles  the  lamp  of  hope,  and  does  the  tim- 
orous and  despondent  as  much,  or  more,  good  than  a  prescrip- 
tion. It  is,  therefore,  your  duty  to  gain  and  retain  the  confi- 
dence of  your  patient  and  his  friends  by  all  honorable  means, — 
to  be  gay,  pleasant,  amusing,  serious,  or  sympathizing,  as 
occasion  requires. 

It  is  often  very  pleasing  to  the  sick  to  be  allowed  to  tell,  in 
their  own  way,  whatever  they  deem  important  for  you  to  know  ; 
allow  to  all  a  fair,  courteous  hearing,  and,  even  though  Mr. 
Humdrum's  and  Mrs.  Lengthy 's  long  statements  are  tedious,  do 
not  abruptly  cut  them  short,  but  endure  and  listen  with  calm, 
respectful  attention.  A  patient  may  deem  a  symptom  very  im- 
portant that  you  know  to  be  otherwise,  yet  he  will  not  be  satis- 
fied with  your  views  unless  you  show  sufificient  interest  in  all  the 
symptoms  at  least  to  hear  them  described.  When,  for  want  of 
time,  you  cannot  listen  further,  or  where  the  recital  grows  too 
tedious  and  becomes  too  irrelevant,  do  not  lose  temper  or  manifest 
any  annoyance,  or  check  him  by  a  rude  order  to  "  stop,"  but 
quietly  ask  him  a  diverting  question  about  his  sickness,  or  to 
show  his  tongue,  or  feel  his  pulse,  as  if  completing  your  exami- 
nation. Such  expedients  often  serve  the  purpose  with  hypochon- 
driacal men,  garrulous  women,  and  tedious  chronics  in  general. 


HIS   REPUTATION    AND    SUCCESS.  51 

To  be  quick  to  see  and  understand  your  duty,  and  equally 
prompt  and  self-reliant  in  doing  it,  as  if  possessed  of  inborn  acute- 
ness  of  perception  and  of  intuitive  skill,  is  one  of  the  strongest 
points  you  can  possess,  and  gives  easy  advantage  over  Dr.  Lazi, 
Dr.  Dragg,  and  Dr.  Dallhead,  who  mildly  and  formally  perform 
their  part,  and  are  as  painfidly  slow,  undetermined,  and  cau- 
tious, as  if  every,  pebble  were  a  rock  and  every  molehill  a 
mountain.  People  invariably  admire  and  appreciate  the  man 
who  can  take  the  responsibility  in  critical  moments ;  indeed,  a 
bold,  prompt  act,  done  at  the  opportune  moment,  with  steadiness 
of  mind  and  nerve,  if  successful,  often  creates  a  species  of  faith 
bordering  on  professional  idolatry. 

Capital  operations  in  surgery  illustrate  this :  the  manual 
parts — expertness  with  the  knife,  etc. — are  deeply  impressive, 
and  receive  vastly  more  praise  from  the  crowd  than  knowing 
when  to  operate  and  how  to  conduct  the  after-treatment.  In- 
deed, the  public  imagine  that  the  comparative  scarcity  of  sur- 
geons is  because  but  few  of  our  number  dare  to  do  great  oper- 
ations. The  truth  is,  almost  every  physician  does  minor 
surgery, — adjusts  fractures,  reduces  dislocations,  etc., — and  would 
prepare  to  perform  capital  operations  but  for  the  reason  that 
only  a  few  are  required  to  do  all  there  is  to  be  done,  and  only 
a  very  few  can  live  by  it.  A  large  city  with  its  hundreds  of 
physicians  will  have  less  than  a  dozen  who  are  prepared  to  do 
capital  operations,  and  the  majority  of  these  have  a  great  deal 
more  medical  than  surgical  practice. 

If  you  know  a  patient's  ailments  so  well  as  to  sit  down  and 
tell  him  and  his  friends  exactly  how  he  feels  better  than  he  can 
tell  you,  he  will  be  apt  to  believe  all  you  afterward  say  and  do. 
Mind-reading,  or  the  study  of  character,  is  part  of  your  duty. 
To  be  many-sided ;  to  possess  flexibility  of  temper  and  suavity 
of  manner,  self-command,  quick  discernment,  address,  ready 
knowledge  of  human  nature,  and  the  happy  genius  of  honestly 
adapting  yourself  to  A-arying  circumstances  and  to  all  people,  at 
the  couch  of  splendor  and  the  squalid  cot,  are  great  necessities 


62  THE   PHYSICIAN    HIMSELF: 

in  our  checkered  profession.  You  will  meet  patients  of  various 
and  even  of  directly  opposite  temperaments  and  qualities :  the 
refined  lady  and  the  liod-carrier,  the  clergyman  and  the  beer- 
seller,  the  aged  and  the  young,  the  hopeful  and  the  despondent, 
the  bold  and  the  diffident,  the  profound  and  the  superficial.  Let 
each  and  all  find  in  you  his  ideal.  Seek  to  penetrate  the  char- 
acter of  each,  and  to  become  an  adept  in  adapting  your  manner 
and  language  to  whoever  and  whatever  is  before  you. 

If  you  also  have  the  self-command  to  control  your  emo- 
tions, temper,  and  passions,  and  to  maintain  a  cool,  philosophic 
equipoise  and  inflexible  serenity  of  countenance,  under  the 
thousand  irritative  provocations  given  to  you  by  foolish  patients 
and  their  querulous  and  rude,  or  fidgety  friends,  who  rile  at  your 
coming  too  early  or  too  late,  too  often  or  not  often  enough,  or 
accuse  you  of  giving  the  wrong  medicine  or  in  the  wrong  doses, 
of  being  too  fast  or  too  slow,  it  will  give  you  great  advantage 
at  the  critical  moment  over  nervous,  quick-tempered,  and  excit- 
able physicians  who  unguardedly  blurt  out  with  " , : ; 

!!'?'? *]!!! !! -V',    and  will   generally    redound    both 

to  your  advantage  and  credit. 

A  brusque,  tornado-like  manner,  or  eccentric  rudeness,  is 
fatal  to  a  physician's  success  uuless  sustained  by  unquestionable 
skill  or  reputation.  A  simple,  humane,  gentle,  and  dignified 
manner  and  low  tone  of  voice  are  suitable  to  the  largest  part  of 
the  community. 

"Manners  gentle,  discourse  pure." 

E^member  that  a  rough,  unfeeling,  abrupt,  indelicate,  sour,  or 
arbitrary  manner,  as  if  the  heart  were  a  butcher's,  or  made  of 
marble,  is  quite  different  from  the  serene  composure  and  intelli- 
gent sympathy  acquired  by  constant  attendance  upon  the  sick  and 
suftering.  The  former  is  brutal  and  unprofessional ;  the  latter 
is  essential  to  enable  you  to  weigh  correctly  and  manage  diseases 
skillfully. 

If  you  chance  to  inherit  any  slight  but  pleasant  pecu- 
liarity of  character  or  singularity  of  manner  it  will  be  noticed, 


HIS   REPUTATION    AND    SUCCESS.  53 

and,  if  not  disagreeable,  will  do  you  no  harm ;  *  but  never 
assume  one  for  the  sake  of  making  an  impression  on  the  public, 
for  the  counterfeit  is  easily  detected  by  all  sensible  men  and 
women.  Be  not  only  a  gentleman,  but  also  a  gentle  man,  and 
{jct  out  your  own  natural  character  every  where  and  at  all  times, 
among  the  rich  and  the  poor  (no  man  has  two  natural  manners). 
Besides  making  himself  ridiculous,  a  physician  who  assumes  a 
fictitious,  mysterious,  or  rude  manner  must  either  be  wrong- 
hearted  or  weak-headed. 

If,  moreover,  you  possess  fluency  of  language,  or  the  gift 
of  conversational  power,  or  gentleness  or  tenderness  of  manner, 
or  great  natural  courtesy,  or  a  never-failing  stock  of  politeness, 
facility  of  expression,  or  a  talent  for  illustrating  your  points  by 
apt  comparisons,  or  a  bold,  resolute  way  of  encountering  pro- 
fessional puzzles,  or  of  deftly  catting  the  many  Gordian  knots 
so  often  encountered,  it  will  help  you  decidedly.  If,  on  the  con- 
trary, there  is  any  point  in  which  you  are  deficient,  study  and 
practice  until  you  attain  it. 

When  you  reach  a  patient's  house  ascertain,  if  possible, 
from  whoever  meets  you,  his  condition,  etc.,  that  you  may  know 
with  what  manner  to  approach  him,  especially  in  cases  of 
severe  illness,  in  which  it  is  important  to  show  him  no  surprise, 
nor  to  disturb  him  with  questions  that  can  be  avoided. 

Never  leave  a  bedside  before  qualifying  yourself  to  com- 
municate your  ideas  and  opinions  of  a  case  to  the  inquiring 
friends  of  the  patient  clearly,  in  well-chosen  and  faith-inspiring 
language,  in  case  they  should  be  asked. 

Never  utter  a  diagnosis  or  a  prognosis  in  a  hurry  or 
flurry.  Give  your  opinion  only  after  sufficient  thought,  and, 
if  possible,  do  not  afterward  change  it.  Also,  to  prevent 
being  misunderstood,  avoid  making  varying  statements  about 
a  case  to  different  inquirers  from  time  to  time,  but,  as  nearly 
as  possible,  use  the  same  tactful  words  and  apply  exactly  the 

*It  is  said  that  the  thee  and  thou  of  Dr.   Fothergill,  of  London,  was  worth 
£2000  per  year  to  him. 


54  THE    PHYSICIAN    HIMSELF: 

same  terms  to  the  disease,  and  even  more  particularly  in  consul- 
tation cases. 

Act  toward  timid  children  and  nervous  patients  so  as  to 
remove  all  dread  of  your  visits.  Avoid  a  set,  sad  countenance, 
and  a  formal  or  funereal  solemnity  of  manner,  as  these  would 
excite  thoughts  of  crape,  hearse,  undertaker,  and  tombstone, 
and  a  fear  of  you,  especially  if  you  associate  them  with  a 
corresponding  style  of  dress.  If  you  have  a  lengthened,  severe 
visage,  simulating 

"A  walking  prayer-meeting," 

or  your  air  and  movements  are  awkward,  sombre,  severe,  smile- 
less  or  singular,  offset  them  by  enforced  cheerfulness,  suitable 
dress,  etc. 

When  you  visit  a  patient,  neither  tarry  long  enough  to 
become  a  bore  and  give  rise  to  the  wish  that  you  would  go,  nor 
make  your  visit  so  brief  or  abrupt  as  to  leave  the  patient  with 
the  impression  that  you  have  not  given  his  case  the  necessary 
attention. 

To  evince  an  earnest,  anxious,  tender  interest  in  the  welfare 
of  patients,  and  serious  attention  to  the  nature  of  their  disease, 
and  sympathy  with  their  sufferings,  as  if  you  were  present  in 
mind  as  well  as  in  body,  is  another  very  strong,  faith-inspiring 
quality.  To  find  occasion  to  assure  a  sufferer  that  you  will 
take  the  same  care  of  him  as  tliough  he  were  your  "  own 
brother,"  or,  in  case  it  be  a  female,  as  if  she  w^ere  your  "  own 
sister,"  or  to  assure  a  female  in  labor  that  you  will  be  as  gentle 
in  making  the  necessary  examinations  as  if  she  were  an  infant, 
and  similar  trutli fully-meant  expressions  of  sincere  sympathy 
and  interest,  and  letting  your  conduct  be  such  that  they  may 
feel  it  is  so,  inspire  great  confidence,  and  are  often  quoted  long 
after  the  physician  has  used  them. 

"A  little  thing  often  helps." 

The  world  is  full  of  objects  of  pity,  and  it  may  be  that  no 
really  busy  physician  can  devote  full  time  and  exert  his  utmost 
skill  in  every  case  that  appeals  to  him,  or  throw  into  it  his 


HIS   REPUTATION    AND    SUCCESS.  55 

whole  heart,  undivided  force,  tlioughts,  feelings,  and  intellec- 
tual strength  ;  or  even  feel  deep  interest  in  the  agonies,  the  woes, 
the  bruises,  the  afflictions,  and  sufferings  of  every  patient  to 
whom  he  is  called  ;  if  he  did,  the  endless  chain  of  misery  with 
which  he  is  brought  in  contact  would  prove  to  be  too  great  a 
strain  on  his  sensibilities,  and,  through  overcare  and  grief,  would 
soon  unfit  him  for  active  practice.  But  you  can,  and  should  at 
least,  make  a  careful  examination,  in  a  grave  and  thoughtful 
manner,  manifest  liumane  anxiety  and  intelligent  interest,  and 
show  uniform  kindness  in  all  cases,  and  avoid  exhibiting  a 
rough,  abrupt  manner,  unfeeling,  thoughtless  haste,  or  chilly  in- 
difference in  any.  Be  careful  to  approach  the  sick,  rich  and 
poor  alike,  with  noiseless  step,  with  kindly,  hopeful  greeting, 
and  gentle,  thoughtful  speech.  The  possession  of  a  feeling  of 
true  humanity,  or  the  lack  of  it,  in  a  physician,  can  in  no  way 
be  so  accurately  judged  as  in  his  questioning  and  examination 
of  the  sick ;  the  soothing  voice,  the  tender  touch,  and  the  sym- 
pathetic feeling  tend  not  a  little  to  soften  the  pillow  of  sorrow 
and  affliction. 

In  examining  the  sick,  be  especially  careful  to  use  the  pro- 
fessional touchy  and  avoid  inflicting  pain  in  delicate  and  painful 
parts,  and  assuage  their  fears  and  oversensitiveness  by  assur- 
ances that  you  will  not  cause  any  more  suffering  than  is  una- 
voidable, and  then  proceed  to  make  good  your  words.  He  who 
possesses  such  manner  and  tact  naturally  will  not,  cannot,  fail 
to  gain  devoted  patients,  who  will  willingly  trust  and  retain  him 
in  preference  to  all  others,  even  though  they  know  his  general 
reputation  for  skill  to  be  far  below  that  of  professional  neigh- 
bors. 

Human  life  is  precious  above  all  on  earth  ;  but  some  per- 
sons think  that  being  so  often  in  contact  with  sickness  and 
death  naturally  makes  pliysicians  less  alive  to  life's  value  and 
more  callous  to  suffering  than  other  men,  and  nothing  is  more 
gratifying  to  all,  and  especially  to  such  as  are  interested  in  one 
who  is  lying  sick,  than  to  hear  the  physician  expressing  a  lofty 


56  THE   PHYSICIAN    HIMSELF: 

estimate  of  the  value  of  human  life  in  general,  and  why  the  life 
then  at  stake  is  specially  valuable,  and  wortliy  of  an  earnest 
determination  on  the  part  of  all  to  save  it  if  possible. 

For  ultimate  success  you  must,  of  course,  depend  chiefly 
on  your  skill  in  curing  the  sick.  You  will  find,  nevertheless, 
that  but  few  patients — probably  not  one  in  twenty — can  estimate 
the  amount  of  technical  and  scientific  knowledge  you  possess. 
The  majority  are  governed  by  the  care  and  devotion  you  ex- 
hibit, and  form  their  opinion  and  rate  your  services  by  the 
little  details  of  routine  attention,  which  is  additional  evidence 
that  mere  skill  is  not  all  that  is  necessary  to  make  a  successful 
physician. 

While  civil  and  urbane  to  all,  without  distinction,  be 
especially  courteous  to  female  attendants  on  the  sick ;  for  woman, 
noble  woman !  as  true  to  duty  as  Diana,  with  voice  soft,  gentle, 
and  low,  and  the  look  of  heaven  in  her  face,  is,  and  ever  will  be, 
the  angel  of  the  sick-room, — 

"Sweet  is  her  voice  in  the  season  of  sorrow," — 

and  you,  as  a  physician,  cannot  fail  to  witness  many  touching 
evidences  of  her  tender  ministrations;  and  heroic,  unselfish  de- 
votion as  mother,  wife,  sister,  daughter,  nurse,  or  friend  to  the 
sick  and  suffering,  watching  around  the  bedside  by  day  and  by 
night,  and  ministering  with  an  angel's  spirit,  even  at  the  risk 
of  her  own  life. 

"Woman,  fairest  of  creation,  God's  last  and  best  gift  to  man." 

After  a  patient  convalesces,  or  when  it  is  not  necessary  to 
visit  him  daily,  if,  when  you  chance  to  be  attending  in  his  neigh- 
borhood, you  send  to  inquire  how  he  is  getting  along,  it  will  not 
only  give  you  the  desired  information,  but  will  also  impress  him 
and  his  with  a  grateful  sense  of  your  interest  in  the  case.  Having 
a  sick  child  taken  up  for  examination,  carrying  your  patient  to 
the  light  that  you  may  see  him  fully  and  examine  him  carefully, 
also  having  his  urine,  or  his  sputa,  or  tlie  blood  spat,  etc.,  saved 
for  examination,  will  not  only  give  you  much  necessary  informa- 


HIS   REPUTATION    AND    SUCCESS.  57 

tion  as  to  the  patient's  condition,  but  also  satisfy  him  and  the 
family  of  your  interest  and  solicitude,  and  of  your  anxiety  to 
fulfill  your  duty.  A  like  effect  is  also  produced  by  paying-  one 
your  first  visit  in  the  mornino-,  or  the  last  at  night,  or  staying, 
in  urgent  cases,  to  see  that  the  medicine  produces  the  desired 
effect,  and  such  things  help  to  make  the  cure. 

You  will  find  that,  in  times  of  sudden  sickness  and  alarm 
in  families,  there  is  a  peculiar  susceptibility  to  strong  impressions, 
and  kindness  and  extra  attention  shown  them  in  such  emergen- 
cies is  doubly  appreciated.  Often  even  a  single  kind  expres- 
sion, opportunely  uttered,  is  long  remembered.  Indifference, 
coldness,  a  slight  offense,  an  inopportune  remark,  an  unlucky 
word,  or  an  impatient  ejaculation,  may,  on  the  contrary,  sever 
attachments  and  terminate  friendships  that  have  existed  between 
the  physician  and  the  family  for  years,  in  as  many  moments. 
Many  a  young  physician  gains  a  hold  on  the  hearts  of  a  good 
family,  becomes  beloved,  and  secures  the  family  permanently  by 
the  exhibition  of  good,  hopeful  intentions,  and  simple  kindness 
and  assiduous  attention  in  those  dreadful  accidents  and  emer- 
gencies that  alarm  friends  and  distress  families ;  and,  also,  in 
cases  of  colic,  convulsions,  and  the  like ;  or  by  sleepless  anxiety 
and  faithful,  devoted,  and  unwearied  attention,  trying  to  steer 
here  to  avoid  this  rock,  and  there  to  escape  that  eddy,  in  cases 
of  typhoid  fever,  scarlet  fever,  etc.,  where,  perhaps,  life  hangs, 
day  after  day,  as  if  by  a  single  thread. 

A  powerful  lever  to  assist  in  establishing  your  professional 
reputation  will  be  found  in  curing  the  long-standing  cases  so 
often  seen  among  the  poverty-stricken.  Many  of  these  poor, 
disease-ridden  sons  and  daughters  of  poverty  are  curable,  but 
require  greater  attention  in  regard  to  the  details,  and  a  great 
deal  more  care,  strength,  and  personal  superintendence  than 
old-established  physicians,  whose  time  is  monopohzed  by  acute 
cases,  can  possibly  devote  to  them.  If  you  are  seriously  in 
earnest,  use  your  best  judgment,  and  persevere  with  them  until 
a  cure  is  effected ;  your  special  interest  and  anxious  attention  will 


58  THE    PHYSICIAN    HIMSELF  I 

be  observed  and  appreciated ;  you  will  be  credited  with  all  the 
prosperous  accidents  of  the  case,  get  the  credit  of  the  cure,  and 
gain  a  host  of  warm  admirers,  who  will  magnify  and  herald  you 
far  and  wide  as  being  doubly  skillful  in  making  the  blind  see, 
the  deaf  hear,  the  lame  walk,  the  broken  whole  again,  the 
senseless  well,  the  weak  and  debilitated  strong,  rotten  lungs 
sound  again  ;  and,  even  though  you  receive  little  or  no  pecuniary 
reward  from  them,  it  will  serve  as  a  mental  gymnasium,  help  to 
train  and  develop  your  professional  character,  show  your  skill 
and  ingenuity,  augment  your  fame,  and  educate  both  your  hand 
and  your  eye,  and  school  you  in  the  art  of  recognizing,  studying, 
and  treating  the  very  diseases  you  will  daily  be  called  upon  to 
attend  all  the  days  of  your  life ;  besides,  teaching  you  to  over- 
come the  thousand  and  one  embarrassments  encountered  by 
the  beginner,  and  bring  you  eventual  success  in  life.  And  when 
success  does  come,  forget  not  those  by  wliom  it  came,  and  with 
grateful  heart  be  true  to  all  the  friends  of  your  struggling  years. 

"Thine  own  friend,  and  thy 
Father's  friend,  forsake  not." 

Take  care  to  promise  old  chronic  cases — that  more  experi- 
enced physicians  have  pronounced  incurable,  and  annoying  and 
troublesome,  but  penniless  patients,  taken  for  older  physicians 
who  wish  to  discard  them — nothing  but  that  you  will  do  your 
best  for  them.  Never  stake  your  reputation  on  their  cure,  and 
allow  yourself  plenty  of  time  in  speaking  of  the  period  necessary 
for  the  trial,  instead  of  promising  too  much,  or  good  results 
too  soon. 

You  will  find  it  comparatively  easy  to  get  practice  in  the 
slums  and  among  the  moneyless  poor,  and  relatively  hard  to  do 
so  among  the  wealthier  classes.  Your  practice  will  probably 
begin  in  cellars  and  garrets,  lanes  and  back  streets,  among 
the  poorest  of  the  poor,  the  degraded  and  the  vicious, — even  in 
hovels  of  filth  and  vermin,  in  putrid  alleys  and  fetid  courts,  where 

"I  have  counted  two-and-seventy  stenches, 
All  well  defined." 


HIS   REPUTATION    AND    SUCCESS.  59 

You  will  also  be  called  to  attend  people  who  wash  with  invisible 
soap,  in  imperceptible  water,  and  use  immaterial  towels,  who 
will  furnish  astonishing  illustrations  of 

"  The  survival  of  the  filthiest  ;  " 

and  will  also  enter  dens  of  iniquity  and  vice,  where  you  must 
pick  your  way  through  mud  and  mire  amid 

"  Poverty,  hunger,  and  dirt," 

where  your  reputation  will  extend  much  more  rapidly  than  in 
comfortable  quarters  ;  but,  no  matter  whether  in  mansion,  cottage, 
or  hovel,  every  man,  woman,  or  child  you  attend,  white  and  black, 
rich  and  poor,  will  aid  in  enriching  your  experience  and  in  shap- 
ing public  opinion  by  giving  you  either  a  good  or  a  bad  name. 

"  Over  rough  roads,  indeed, 
Lies  the  way  to  medical  glory." 

Bear  in  mind  that  the  wheel  of  fortune  sometimes  makes 
the  poor  rich,  and  a  few  of  the  more  grateful  kind  then  remember 
the  physician  who  remembered  them.  Attending  the  servants 
of  the  rich,  however,  who  are  sick  at  their  service  places,  or  paid 
for  by  the  latter,  will  not  improve  your  reputation  much  with 
the  powers  above  stairs :  at  any  rate,  not  nearly  so  much  as 
attending  the  same  patients  at  their  own  homes,  or  on  their  own 
account.  Proud  and  haughty  people  who,  in  their  minds, 
couple  you  professionally  with  their  servants,  garrets,  and 
kitchens  are  apt  to  form  a  low  opinion  of  your  status,  and  of  the 
nature  and  class  of  your  practice.  It  is  also  true  that  if  you 
attend  a  poor  person  gratuitously  you  will  seldom,  if  ever,  be 
called  to  his  rich  relatives;  and  if  Dame  Fortune  ever  makes 
that  poor  patient  rich,  even  he  may  become  supercilious,  and 
drop  you. 

Nor  will  you  find  it  very  satisfactory  to  attend  people  who 
"just  call  you  in  to  see  a  sick  member  of  their  family,"  because 
you  are  attending  across  the  street  or  in  the  neighborhood. 
Those  who  select  you  or  send  for  you  because  they  prefer  you 
to  all  others  will  be  your  best  and  most  devoted  patients. 

The  adoption  of  a  specialty,  to   the  exclusion   of  other 


60  THE    PHYSICIAN    HIMSELF: 

varieties  of  practice,  is  successful  with  but  a  few  of  those  who 
attempt  it.  It  should  never  be  undertaken  without  first  study- 
ing the  whole  profession  and  attaining  a  few  years'  experience 
as  a  general  practitioner. 

You  are  not  obliged  to  assume  charge  of  any  case,  or  to 
engage  to  attend  a  woman  in  confinement,  or  to  involve  your- 
self in  any  way  against  your  wish ;  but,  after  doing  so,  you  are 
morally,  if  not  legally,  bound  to  attend,  and  to  attend  properly, 
even  though  it  may  be  a  charity  or  "  never  pay  "  patient.  At 
the  same  time  you  liave  a  right,  should  necessity  arise,  to  with- 
draw from  any  case  by  giving  proper  notice. 

Bear  in  mind  that  ethical  duties  and  legal  restraints  are 
as  binding  in  pauper  and  charity  cases  as  in  any  other,  for  both 
ethics  and  law  rest  upon  abstract  principles,  and  govern  all  cases 
alike. 

You  will  probably  find  hospital  and  dispensary  patients, 
soldiers,  sailors,  and  the  poor,  much  easier  to  attend  than  the 
higher  classes ;  their  ailments  are  more  simple,  definite,  and  un- 
complicated, the  treatment  more  clearly  indicated,  and  the  re- 
sponse of  their  system  is  generally  more  prompt,  and  one  can 
usually  predict  the  duration,  issue,  etc.,  of  their  cases  with  great 
accuracy.  With  the  wealthy  and  pampered,  on  the  other  hand, 
there  is  often  such  a  concatenation  of  unrelated  or  chronic 
symptoms  and  strange  sympathies,  or  they  are  described  in  such 
indefinite  or  exaggerated  phrases,  that  it  is  difficult  to  judge 
which  one  symptom  is  most  important  to-day  or  which  will  be 
to-morrow. 

With  hospital  patients,  sailors,  soldiers,  paupers,  etc.,  on 
the  contrary,  there  are  but  two  classes, — the  really  sick,  suffer- 
ing from  affections  of  a  well-marked  type,  and  malingerers. 
Such  practice  is  apt  to  lead  the  unguarded  youth  to  a  rough-and- 
ready  habit  of  treating  every  patient  as  very  ill,  or  else  as 
having  little  or  nothing  the  matter  with  him;  later,  he  finds 
that  these  crude  or  possibly  overactive  methods  may  answer  in 
public  institutions,  but  they  will  not  suit  the  squeamish  people 


HIS   REPUTATION    AND    SUCCESS.  61 

with  nerves  tuned  to  a  high  key,  so  often  seen  in  private  practice, 
with  indefinite  or  frivolous  ailments,  for  which  the  physician 
trained  in  a  hospital  could  hardly  fail  to  feel  and  manifest  con- 
tempt. Hospital  practice  is  so  different  from  private  that  but 
few  members  of  our  profession  shine  conspicuously  as  practi- 
tioners in  both  spheres.  An  illustration  of  this  fact  is  afforded 
in  colleges  and  medical  societies;  for  the  greatest  Ciceronian 
orators  in  the  colleges,  and  the  most  fluent  debaters  and  paper 
philosophers  in  medical  societies,  are  not  necessarily  the  best  or 
most  successful  practitioners.  The  fields  are  decidedly  different, 
and  may  lead  the  mind  in  different  directions.  In  a  word,  the 
possession  of  didactical  knowledge,  and  the  power  of  applying 
it  at  the  bedside,  are  very  different  things. 

Observe  and  strictly  practice  every  acknowledged  rule  of 
professional  etiquette.  For  this  purpose  it  is  your  duty  to 
familiarize  yourself  at  the  very  threshold  of  your  professional 
career  with  the  "  Code  of  Ethics  of  the  American  Medical  As- 
sociation," and  never  to  violate  either  its  letter  or  its  spirit,  but 
always  scrupulously  to  observe  botli  toward  all  regular  gradu- 
ates practicing  as  regular  physicians.  But  remember  that  you 
are  neither  required  nor  allowed  to  extend  its  favoring  pro- 
visions to  any  one  practicing  contrary  to  the  liberal  tenets  that 
govern  all  regular  physicians,  no  matter  who  or  what  he  may  be. 

I  am  not  sure  that  the  medical  profession  of  any  other 
country  besides  ours  has  a  code  of  written  ethics.  Possibly  old 
countries  from  long  custom  can  dispense  with  them.  But  in  our 
Young  Land  of  Freedom  the  very  nature  of  society  requires  that 
physicians  shall  have  some  general  system  of  written  ethics  to 
define  their  duties,  and,  in  cases  of  doubt,  regulate  their  conduct 
toward  each  other  and  the  public  in  their  intercourse  and  com- 
petition. Every  individual  in  the  profession  is,  of  course,  sup- 
posed to  be  a  gentleman,  actuated  by  a  lofty  professional  spirit, 
striving  to  do  right  and  to  avoid  wrong,  and,  even  were  there 
no  written  rules  at  all,  the  vast  majority  would  naturally  con- 
form to  the  rules  of  justice  and  honor,  as  far  as  they  understood 


62  THE   PHYSICIAN    HIMSELF: 

them.  As  a  consequence,  each  one's  action,  when  scanned  by 
watchful  and  knowing  eyes,  might  probably  be  considered  fair 
in  nine  doubtful  cases  out  of  ten,  while  in  the  tenth  one  might 
lionestly  err  greatly,  or  conclude  differently  from  his  neighbor 
on  some  mooted  point,  or  might  be  found  differing  in  opinion 
only  from  some  jealous  or  captious  rival,  or  crafty,  unprincipled 
competitor,  with  whom  an  honorable  agreement  would  be 
impossible. 

The  absence  of  rules  for  our  government  would  also  leave 
Dr.  AUforself  and  others  at  liberty  to  frame  their  own  codes, 
which  might  violate  all  logic  and  all  propriety, — 

"  The  wrong-doer  never  lacks  a  pretext," — 

and  no  matter  how  equivocal  their  position,  or  how  crooked  and 
insincere  their  ways,  no  one  would  be  in  position  to  prove 
that  they  acted  from  unworthy  motives,  and  not  from  error  of 
judgment,  even  in  the  most  flagrant  violation  of  the  cardinal,  the 
glorious  old-fashioned  Golden  Rule,  the  climax  of  all  ethics,  laid 
down  by  Confucius,  and  quoted  by  "  Our  Saviour,"  "  Do  unto 
another  what  ye  would  he  should  do  unto  you,  and  do  not  unto 
another  what  you  would  not  sliould  be  done  unto  you," — truly, 
a  world  of  ethics  in  a  nutshell,  an  ocean  of  morals  in  a  drop. 

The  non-existence  of  a  code  would  also  make  it  possible 
for  Dr.  G.  to  pounce  on  the  patients  of  Drs.  A.,  B.,  C,  D.,  E., 
and  F.  like  a  wolf  on  sheep,  and  to  carry  on  a  regular  system 
of  infringements,  self-advertising,  certificate-giving,  and  wrong- 
doing in  general,  regardless  of  their  rights,  and  still  claim  to  be 
as  honorable  as  Socrates,  while  those  aggrieved  would  have 
no  visible  standard  of  appeal  by  which  the  contrary  could  be 
proved. 

In  view  of  these  and  many  other  facts,  it  has  been  found 
necessary  to  have  a  code  of  written  ethics  for  regulating  the 
conduct  of  physicians  toward  each  other  and  toward  the  public 
generally. 

Dr.  Thomas  Percival,  an  English  physician,  in  a  small  book 
published  in  London  in  1807,  proposed  an  admirable  code  of 


HIS   REPUTATION    AND    SUCCESS.  63 

ethics,  which,  excepting  a  few  alterations  made  necessary  by  the 
lapse  of  time  and  the  advance  of  medical  science,  is  the  identical 
code  adopted  by  the  American  Medical  Association  in  1847,  and 
which  from  then  until  now  has  instructed  and  governed  nine- 
tenths  of  our  profession  throughout  this  broad  land,  protecting 
the  good  and  restraining  the  bad,  just  as  the  Ten  Command- 
ments of  Holy  Writ  instruct  and  restrict  mankind  in  general. 

You  and  every  other  true  physician  among  us  unquestion- 
ably owe  to  it  his  sacred  allegiance. 

You  and  all  other  physicians  are  supposed  to  have  studied 
this  code,  and  to  be  familiar  with  its  requirements.  The  moral 
claim  which  it  has  upon  you  rests  not  upon  any  obligation  of 
personal  friendship  toward  your  professional  brethren,  but  upon 
the  fact  that  it  provides  for  every  relation,  contingency,  and  occa- 
sion, and  is  founded  on  the  broad  basis  of  justice  and  equal 
rights  to  every  member  of  the  profession,  shining  like  the  pole- 
star  to  guide  and  direct  all  who  wish  to  pursue  an  honorable 
course ;  and,  being  founded  on  the  highest  moral  principles,  its 
precepts  can  never  become  useless  till  regenerate  and  infallible 
human  nature  makes  both  codes  and  commandments  unneces- 
sary. It  is  the  great  oracle  of  right  and  reason,  to  which  you 
can  resort  and  study  the  moral  aspect  of  all  the  subjects  that 
are  likely  to  confront  you  from  time  to  time,  and  no  better  code 
of  moral  principles  can  be  found  anywhere. 

To  this  lofty  code,  in  a  great  measure,  is  due  the  binding 
together  and  elevation,  far  above  ordinary  avocations,  of  the 
medical  profession  of  our  land,  and  the  esteem  and  honorable 
standing  which  it  everywhere  enjoys. 

By  its  dignity  and  justness  it  remains  as  fresh  and  useful 
to-day  as  when  the  profession  adopted  it,  more  than  forty  years 
ago,  and  if  you  faithfully  observe  its  canons  you  can  truthfully 
exclaim :  "  I  feel  within  me  a  peace  above  all  earthly  dignities, 
a  clear  and  quiet  conscience." 

Professional  morals  are  an  important  part  of  medical  edu- 
cation, and  it  is  as  much  the  duty  of  every  medical  college  in 


64  THE   PHYSICIAN   HIMSELF  I 

America  to  acquaint  its  students  with  the  precepts  of  the  code 
of  ethics  of  the  American  Medical  Association,  and  to  furnish 
to  each  of  its  alumni  a  copy  of  it  with  his  diploma,  as  it  is  for 
a  mother  to  familiarize  her  children  with  the  Ten  Command- 
ments. 

In  our  land  the  code  is  regarded  as  the  balance-wheel  that 
regulates  all  professional  conduct,  and  neither  Professor  Bigbee 
nor  Dr.  Littlefish  can  openly  ignore  it  without  overthrowing  that 
which  is  vital  to  his  standing  among  medical  men.  If  in  the 
struggle  and  competition  for  practice  you  desire  to  act  unfairly 
toward  your  brethren,  the  code  will  compel  you  to  do  the  evil 
biddings  of  your  heart  by  stealth ;  and  even  then  your  unfair- 
ness will  seldom  go  undetected  or  unpunished,  for  the  great  God 
of  Heaven  has  declared  that  "  Whatsoever  a  man  soweth,  that 
shall  he  also  reap."  Any  one  upon  whom  you  encroach  in  an 
unprofessional  manner  will  feel  himself  justified  in  retaliating 
with  your  own  weapons,  and  you  will  reap  a  crop  similar  to  the 
seed  sown.  AVhenever  you  sow  a  thistle  or  a  thorn  you  will 
reap  thistles  or  thorns,  whenever  a  wind  is  sown  a  whirlwind 
will  be  reaped ;  whilst  the  sweeter  seeds  sown  by  others  will  be 
yielding  to  them  sweeter  fruits. 

When  called  to  attend  a  case  previously  under  the  care  of 
another  physician,  especially  if  the  patient  and  friends  are  dis- 
satisfied with  the  treatment,  or  if  the  case  is  likely  to  prove 
fatal,  be  carefully  just.  Do  not  disparage  the  previous  attend- 
ant by  expressing  a  wish  that  you  had  been  called  in  soojer, 
or  criticise  his  conduct  or  his  remedies ;  it  is  mean  and  cow- 
ardly to  do  either.  In  all  such  cases  do  not  fail  to  reply,  to  the 
questions  of  the  patient  or  his  inquiring  friends,  that  your  duty 
is  ivith  the  present  and  future,  not  iciih  tlie  past.  Inform  your- 
self as  to  what  line  of  treatment  has  been  followed  in  the  case, 
but  refuse  either  to  examine  or  criticise  the  previous  attendant's 
remedies.  Let  your  conversation  also  refer  strictly  to  the  pres- 
ent and  future  and  not  to  the  past,  and  in  no  way  allude  to 
the  physician  superseded,  unless  you  can  speak  clearly  to  his 


HIS   REPUTATION    AND    SUCCESS.  65 

advantage.  As  a  rule,  the  less  you  say  about  the  previous 
treatment,  the  better. 

To  take  a  mean  advantage  of  any  one  whom  you  have 
superseded,  besides  being  morally  wrong,  might  engender  a 
professional  hornet,  which,  in  retaliation,  would  watch  with  a 
malignant  eye  and  sting  fiercely  v^'herever  opportunity  offered. 
Eschew  all  sorts  oi'  finesse,  and  let  courtesy,  truth,  and  justice 
mark  every  step  in  your  career.  Seek,  moreover,  to  enhance 
your  profession  in  pubhc  esteem  on  every  fitting  opportunity, 
and  defend  your  brethren  and  your  profession,  also,  when 
either  are  unjustly  assailed.  Indeed,  to  fail  to  defend  the  repu- 
tation of  an  absent  professional  brother,  even  by  a  conspiracy  of 
silence,  when  justice  demands  you  to  speak,  is  not  only  unpro- 
fessional, but  is  more  or  less  dishonorable,  and  implies  a  quasi- 
sanction  of  the  libel. 

Every  physician  has  his  successes,  and  also  his  failures. 
Where  you  are  highly  successful  in  diagnosis,  or  have  worked 
wonders  in  treatment  after  others  have  failed,  observe  a  proper 
degree  of  modesty,  and  avoid  pushing  your  triumph  so  far  as  to 
wound  the  feelings  or  mortify  the  pride  of  your  less-fortunate 
predecessors,  on  the  principle  of 

"Hit  him  again,  he  has  no  friends." 

Take  just  credit,  but  be  guarded  in  your  words  and  actions,  and 
take  no  undue  advantage  of  their  errors,  that  you  may  not  in 
turn  invite  disparagement  or  arouse  hatred. 

"No  man  likes  to  be  surpassed  by  men  of  his  own  level." 

We  all  know  there  are  a  thousand  unwritten  ways  to  show 
an  ethical  spirit  and  a  thousand  undefinable  ways  to  evince  an 
unethical  one.  Wlien  you  doubt  whether  this  or  that  patient  is 
fairly  yours  or  another's,  give  your  rival  the  benefit  of  that 
doubt.  Never  be  tenacious  of  doubtful  rights,  but  let  your 
every-day  conduct,  in  this  and  all  other  respects,  entitle  you  to 
the  esteem  of  your  medical  neiiihbors. 

Also,  while  alive  to  your  own  interests,  do  not  captiously 


66  THE   PHYSICIAN    HIMSELF: 

follow  up  every  trifling  ethical  infringement,  difficulty,  or  ap- 
parent contradiction,  as  if  you  were  ever  on  the  watch  for  provo- 
cations and  angry  collision  with  your  neighhors,  and  courted  a 
war  with  everybody  for  what  you  may  be  pleased  to  call  your 
"  rights."  A  certain  amount  of  jarring  and  clashing  in  a  pro- 
fession like  ours  is  unavoidable  ;  allow  liberally  for  this  ;  school 
your  feelings;  bury  pettiness,  captiousness,  and  narrowness  in 
the  ocean  of  oblivion,  and  maintain  a  friendly  attitude  toward 
all  fairly-disposed  neighboring  physicians.  Unless  you  do  so, 
many  questions  will  arise  that  cannot  well  be  adjusted  by  an 
appeal  to  the  code,  and  you  will  become  involved  in  useless, 
rancorous,  and  endless  controversies  and  reprisals  with  those 
whose  paths  may  happen  to  cross  your  own. 
Sometimes — 

"The  very  silliest  thing  in  life 
Creates  the  most  material  strife." 

You  will  find  it  both  inconvenient  and  embarrassing  to  pass 
and  repass  a  medical  neighbor  between  whom  and  yourself 
there  exists  a  chronic  feud,  or  individual  estrangement,  jeal- 
ousy, and  hatred,  as,  also,  to  meet  any  one  else  with  whom, 
through  enmity  or  otiier  cause,  friendship  and  speaking 
acquaintance  have  ceased.  If  ever  you  have  cause  to  believe  a 
medical  neighbor  has  treated  you  unfairly,  or  misconstrued  your 
own  conduct  or  motive,  instead  of  the  fierce  onslaught  and  bitter 
rejoinder,  go  or  send  directly  to  him,  and  in  an  earnest  but 
urbane  manner  make  or  ask  an  explanation. 

Eschew  all  doubtful  expedients  that  relate  to  getting  patients 
and  profits,  as  though  you  cast  off  or  assume  tlie  code  of  ethics 
just  as  suits  your  purpose ;  and  be  very  careful  not  unjustly  to 
encroach  on  any  other  physician's  practice;  also,  never  attempt 
unjustly  to  retain  any  patient  to  wliom  you  are  called  in  an 
emergency ;  if  you  are  in  doubt  whether  you  were  deliberately 
chosen,  or  only  taken  in  the  emergency,  do  not  hide  yourself 
behind  a  mean  technicality  of  ethics,  but  ask  the  direct  question. 
If  you  learn  that  another  was  really  preferred  to  you,  surrender 


HIS    REPUTATION    AND    SUCCESS.  67 

the  patient  to  him  on  liis  arrival,  even  though  you  may  be,  for 
pohteness'  sake,  asked  to  continue  in  attendance.  Circum- 
stances may  even  require  you  to  have  the  former  attendant  sent 
for  in  a  case,  either  to  take  charge  of  it  or  for  consuUation. 

Acts  of  neighborly  kindness  are  frequently  performed  by 
physicians  for  one  another,  and  go  far,  very  far,  toward  neutraliz- 
ing the  ruffles,  stings,  and  collision  of  interests  which  the  very 
nature  of  our  profession  makes  inevitable.  If  your  conduct 
toward  other  physicians  at  such  times  is  invariably  just  and 
honorable,  as  if  arising  from  a  simple  desire  to  do  that  only 
which  is  right,  it  will  in  due  time  be  recognized  and  appreciated, 
and  will  not  only  assist  in  making  your  road  pleasant,  but,  if 
you  ever  unwittingly  infringe,  one  and  all  will  acquit  you  of  any 
intentional  error. 

When  you  are  called,  in  an  emergency,  to  prescribe  for  a 
patient  who  is  under  the  care  of  another  physician,  it  is  better 
to  leave  for  him  a  copy  of  your  prescription,  that  he,  knowing 
its  exact  character,  may  be  able  to  judge  whether  or  not  he 
should  continue  its  use. 

Be  it  your  invariable  rule  never  to  visit  a  patient  who  is 
under  the  care  of  a  brother  physician,  as  a  "smelling  commit- 
tee," or  medical  detective  for  the  patient's  beneficial  society, 
with  a  view  to  ascertain  whether  he  is  malingering,  or  for  an 
employer,  friend,  or  relative  who  is  anxious  and  apprehensive  in 
regard  to  his  illness,  or  for  one  in  fear  of  an  impending  damage- 
suit,  with  a  view  to  report  thereon,  without  the  distinct  sanction 
of  the  attending  physician.  It  would  be  a  still  greater  wrong 
to  clandestinely  remove  the  bandages  from  fractures,  ulcers,  etc., 
applied  by  another  physician,  whether  it  be  to  change  treatment 
or  merely  to  examine  the  case. 

Be  also  extremely  discreet  and  chary  of  visiting  patients 
under  the  care  and  treatment  of  other  physicians,  even  for  social 
purposes,  as  it  is  a  frequent  cause  of  suspicion  and  contention. 

Never  take  charge  of  a  patient  recently  under  the  care  of 
any  regular  physician  without  first  ascertaining  that  he  has  been 


68  THE    PHYSICIAN    HIMSELF: 

formally  notified  of  the  change.  The  principle  that  governs 
such  cases  is  this :  When  a  person  is  taken  ill  he  is  at  liberty 
to  select  any  physician  he  prefers,  but  after  making  a  selection, 
and  when  the  case  has  been  taken  charge  of,  if  for  any  reason 
whatever  the  patient  wants  to  change,  he  must,  in  doing  so, 
follow  the  established  custom,  for  if  there  are  any  hard  thoughts 
against  the  other  physician,  or  unpleasant  scenes  with  him,  the 
patient  and  his  friends  should  have  them,  not  you. 

The  dissatisfied  persons  who  wish  to  discard  their  medical 
attendant  and  employ  you,  will  sometimes  contend  that  the 
rules  relative  to  taking  charge  of  patients,  recently  under  the 
care  of  another  physician,  are  harsh  and  unjust,  and  peculiar  to 
the  medical  profession.  Neither  of  these  statements  is  true, 
for  our  custom  is  identical  with  that  which  prevails  everywhere 
among  all  classes  of  people,  which  requires  the  formal  discharge 
of  the  old  employe  before  a  new  one  can  take  his  place.  Be- 
sides, no  person,  whether  menial,  mechanic,  or  physician,  can 
fill  a  vacancy  till  one  exists. 

Be  especially  chary  of  taking  cases  in  families  into  which 
you  have  ever  been  called  in  consultation,  more  particularly  if  you 
were  called  in  at  the  former  attendant's  suggestion,  on  account 
of  your  supposed  greater  merits,  for  he,  chagrined  at  his  displace- 
ment, will  be  apt  to  scan  every  feature  of  the  change,  and,  if 
there  be  any  ground  at  all  for  suspicion,  he  will  conclude  that, 
instead  of  obeying  the  Golden  Rule,  and  sternly  refusing  to  sup- 
plant him,  you  have  taken  advantage  of  the  introduction  he 
gave  you,  ingratiated  yourself  in,  and  ungenerously  elbowed 
him  out. 

"I  taught  you  to  swim,  and  now  you  would  drown  me." 

You  will  sometimes  be  called  to  a  patient,  and,  upon  going, 
will  find  that  he  is  under  the  care  of  some  other  physician,  and 
will,  of  course,  refuse  to  attend ;  but  you  will  almost  surely  be 
urged  just  to  look  at  the  patient  and  tell  what  you  think ;  or 
whether  the  attending  physician's  treatment  is  not  wrong ;  or 
to  prescribe  for  him ;  with  the  assurance  that  the  other  physician 


HIS    REPUTATION    AND    SUCCESS.  69 

shall  be  kept  in  ignorance  of  your  visit.  Bear  in  mind  that  honor 
and  duty  require  you  to  do  right  in  these  and  all  other  positions 
in  which  you  may  be  placed ;  not  through  fear,  or  for  policy's 
sake,  but  because  it  is  right  to  do  right,  and  for  the  other  equally 
broad  reason  that  you  yourself  would  be  cognizant  of  the  wrong, 
whether  the  other  knew  of  it  or  not,  and  it  would  lower  you  in 
your  own  eyes ;  decline,  therefore,  courteously  but  firmly,  their 
solicitations,  with  an  impressive  assurance  that  you  desire  to 
possess  your  own  respect  as  earnestly  as  you  do  that  of  others. 
Unless  a  great  emergency  exists,  you  should  determinedly  refuse 
either  to  sit  in  judgment  on  another's  work,  or  in  any  way  to 
interfere ;  if,  however,  the  case  be  one  of  urgency,  your  services 
should  be  rendered  for  the  attending  physician,  and  you  should 
leave  a  note  telling  him  what  you  have  done.  Take  care  to 
make  no  charges  for  such  services. 

When  persons  are  inveighing  to  you  against  an  attending 
physician,  or  one  who  has  been  discarded,  and  finding  fault  witli 
his  treatment,  or  at  the  patient's  being  so  long  unrelieved,  you 
should  never  suggest  that  he  be  discharged,  so  that  you  may 
supplant  him,  as  it  would  seem  like  piracy,  or  intriguing  for  a 
brother's  place  not  vacant. 

The  rules  regarding  previous  attendance  are  much  less 
stringent  in  floating  office  practice  than  in  regular  family  prac- 
tice, and  it  is  not  essential  to  inquire  wliether  an  office  patient 
is  under  the  care  of  another  ;  I  believe  that  all  of  tlie  most 
eminent  physicians  prescribe  for  all  ordinary  office  patients  with 
but  little  regard  as  to  who  has  been  attending,  or  where,  or  when. 
Most  people,  with  long-standing,  or  peculiar,  or  indefinite  ail- 
ments, are  unwilling  to  resign  themselves  to  the  stroke  of  Provi- 
dence until  numerous  physicians  have  been  tried  in  vain ;  and  a 
patient  with  heart  trouble,  cough,  or  a  skin  disease,  will  occa- 
sionally consult  almost  a  dozen  physicians  at  their  offices  in  as 
many  weeks.  The  principle  followed  is  simply  this:  Office  advice 
to  strangers  is  everywhere  cash,  and  the  payment  of  the  fee  frees 
the  patient  to  go  subsequently  to  whomsoever  else  he  pleases. 


70  THE    PHYSICIAN    HIMSELF  I 

You  will  see  much  to  condemn  in  regard  to  ethics,  both  in 
the  profession  and  in  the  laity.  Should  you  ever  feel  constrained 
to  attack  or  impugn  any  one's  conduct,  do  it  in  an  open,  manly 
way,  and  never  covertly  or  anonymously, — for  underhand,  clan- 
destine, and  dark-lantern  attacks  are  despicable. 

"All  ambusbed  attacks  are  botb  cowardly  and  mean." 

Be  punctilious  in  your  endeavors  to  do  every  person  justice. 
If  you  err  at  all  in  this  respect,  let  it  be  in  liberality.  Suffer 
injustice,  rather  than  participate  in  it.  Sometimes,  even  though 
the  letter  of  ethics  allows  you  to  take  a  patient,  it  may  be  un- 
kind or  unwise,  or  brutal  to  do  so;  use  such  opportunities  to 
harmonize,  rather  than  to  disrupt.     You  can  do  this,  and  yet  not 

make  a  habit  of  cheating  yourself  out  of  patients. 

■  *  *  *  *  *  *  * 

Always  keep  some  good  vaccine  virus  on  hand,  both  for  the 
fees  it  secures,  when  there  is  a  demand  for  vaccination,  and  for 
fear  of  a  sudden  outbreak  of  small-pox. 

Vaccination,  although  a  trifling  operation,  is  a  prolific 
cause  of  criticism  and  reproach  to  physicians ;  take  your  time, 
and  do  it  skillfully  and  thoroughly.  In  lieu  of  humanized 
virus  or  arm-to-arm  vaccination,  use  calf-virus  whenever  it  is 
possible  to  obtain  it;  it  is, more  popular,  and  not  capable  of  com- 
municating syphilis,  scrofula,  etc.,  and  needs  less  defense.  In  no 
case  use  any  but  pure  virus,  and  be  ever  ready  to  defend  its 
purity  with  proof  if  any  one  you  vaccinate  suffers  any  mishap 
through  it. 

Remember  that  you  are  legally  as  well  as  morally  bound  to 
vaccinate  a  person  after  promising  to  do  so.  Besides  the  regrets 
and  harsh  criticism  your  neglect  would  generate,  a  suit  for 
damages  might  follow,  if  the  patient  sliould  get  small-pox  while 
awaiting  the  fulfillment  of  your  promise. 

Do  not  begin  the  unjust  custom  of  vaccinating  children 
gratuitously,  in  cases  where  you  have  officiated  at  their  birth, 
as  is  the  habit  with  some.  Make  tlie  same  charge  also  for  re- 
vaccinating  any  one,  to  test  whether  his  former  vaccination  is 


HIS    REPUTATION    AND    SUCCESS.  71 

still  protective,  whether  it  takes  or  not,  as  you  would  if  he 
never  had  been  vaccinated  before,  as  revaccination  succeeds  in 
but  a  small  proportion  of  those  it  is  tried  upon,  and  the  charge 
is  for  making  the  test. 

A  public  vaccine  physician  should  never  insist  upon  vac- 
cinating a  child  or  other  unvaccinated  person  who  is  known  to 
have  a  discreet,  watchful  medical  attendant,  unless  small-pox  is 
actually  prevailing.  They  should,  on  the  contrary,  be  referred 
to  him. 

You  should,  of  course,  make  no  extra  charge  for  repeating 
primary  vaccinations  till  they  take,  no  matter  how  long  the 
interval  between  the  trials;  also,  make  but  one  charge  for  any 
person  who  has  revaccination  attempted,  no  matter  how  often, 
if  during  the  same  epidemic  or  small-pox  scare.  Many  people 
believe  a  vaccination  protects  as  long  as  the  scar  shows  plainly. 
The  truth  is,  a  vaccine  scar  lasts  for  life,  while  the  protective  in- 
fluence of  vaccination  gradually  disappears  in  some  people.  A 
typical  vaccine  scar  merely  shows  the  vaccination  once  took 
properly,  not  that  it  still  protects. 

Some  people  think  a  revaccination  must  be  made  to  take 
anyhow,  even  though  they  are  still  protected  by  the  old  one. 
You  cannot  catch  fish  where  there  are  none,  no  matter  how  you 
bait  your  hook ;  nor  set  a  pile  of  stones  on  fire,  no  matter  how 
good  the  matches. 

Another  error  regarding  small-pox :  Many  people  imagine 
that  it  can  only  thrive  when  the  weather  is  cold ;  this  is  a  mis- 
take, as  it  may  prevail  with  intensity  at  any  season.  Indeed, 
severe  epidemics  of  it  often  prevail  in  tropical  countries  where 
there  is  perpetual  summer. 

Avoid  volunteer  practice,  and  be  very  cautious  how  you  go 
out  of  your  way  to  persuade  people  to  let  you  remove  warts, 
extract  tumors,  efface  tattoo-marks,  destroy  nsevi  or  superfluous 
or  disfiguring  hairs,  and  do  other  minor  surgical  operations 
gratuitously,  Avith  assurances  of  success.  There  is  always  a  pos- 
sibility of  serious  or  fatal  sequelae  ;  the  most  trivial  operation — 


72  THE   PHYSICIAN    HIMSELF: 

even  a  puncture  on  the  tip  of  the  finger  by  a  pin,  needle,  or 
splinter — is  occasionally  followed  by  death,  and  you  should 
not,  especially  in  private  practice,  induce  people  to  let  you 
involve  yourself  for  tlieir  benefit,  without  being  paid  for 
your  risk  and  responsibility;  for  instance,  it  is  an  ugly 
matter  to  have  a  wart  you  have  insisted  upon  tampering 
with  become  an  ulcerating  epithelioma.  It  is  better,  indeed, 
to  avoid  all  unrequited  work,  and  all  gratuitous  responsibility, 
other  than  what  charity  calls  for. 

For  similar  reasons  do  not  persuade  people  to  effect  insur- 
ance on  their  lives,  or  in  any  particular  company,  as  all  such 
ventures  carry  a  possibility  of  disappointment  or  failure  that 
might  involve  you. 

Wisdom  in  recognizing  cases  that  are  likely  to  involve  you 
in  suits  for  malpractice,  and  in  foreseeing  and  forestalling  the 
suits  themselves,  is  also  a  valuable  power.  Take  care  that  this 
wisdom  does  not  come  too  late  or  cost  you  too  much.  Remem- 
ber that  when  you  are  employed  professionally  you  are  regarded 
as  contracting  that  you  possess  and  will  exercise  ordinary  skill 
in  your  profession,  and  that  you  will  be  guilty  of  no  negligence. 
Beyond  this  you  are  not  responsible  for  the  result,  no  matter 
how  bad,  as  medicine  is  not  an  exact  science ;  but  if  you  fail 
either  in  ordinary  skill  or  care,  you  are  legally  liable  to  the 
injured  person  to  the  full  extent  of  the  damage  sustained.  Skill 
should,  of  course,  be  measured  by  the  time  and  place  in  which 
it  is  exercised;  whether  on  land  or  on  ship-board,  in  places 
where  facilities  are  few,  or  where  they  are  many,  are  matters  to 
be  taken  into  account.  In  your  professional  rounds  you  will  not 
find  the  various  diseases  as  clearly  marked  as  tliey  are  in  the 
books, — not  labeled  as  plainly  as  the  bottles  in  a  pharmacy, — 
therefore  a  mistake  in  diagnosis  is  not  sufficient  cause  for  action, 
and  every  physician  may  be,  and  often  is,  mistaken ;  indeed, 
many  cases  are  so  obscure,  or  masked,  or  irregular,  or  compli- 
cated, that  notliing  but  an  autopsy,  and  sometimes  not  even 
that,  can  reveal  their  exact  nature. 


HIS   REPUTATION    AND    SUCCESS,  73 

Never  fail  promptly  to  send  in  your  professional  account  to 
dissatisfied  patients  who  may  be  unjustly  attempting  to  injure 
your  reputation  and  practice,  and  especially  to  such  as  may  be 
threatening-  to  sue  you  for  malpractice,  whether  or  not  you  ex- 
pect them  ever  to  pay  it.  If  you  cowardly  shrink  from  doing  so 
in  such  cases,  it  will  be  quoted  as  proof  that  you  are  guilty  of 
what  they  charge,  and  that  you  know  it.  The  presentation  of  your 
bill  will  give  you  a  better  position  before  the  public,  and  raise  an 
issue  that  greatly  tends  to  checkmate  them.  In  all  such  cases 
do  not  fall  to  charge  the  maximum  fee. 

When  you  are  to  be  a  witness  in  court  in  a  grave  case, 
courteously  but  firmly  decline  to  give  any  person  connected 
with  the  opposite  side  either  a  verbal  or  written  statement  of 
what  you  saw,  heard,  or  observed  in  the  case,  or  what  your 
opinion  is,  or  what  your  testimony  will  be.  Also,  if  need  be, 
dispute  their  right  to  question  you  at  all  on  the  subject. 

If  you  are  yielding  in  this  respect,  you  may  actually  aid 
them  to  set  traps  for  you,  by  distorting  your  statement  from  its 
proper  meaning  and  hitent,  or  to  rebut  it  on  the  witness-stand, 
or  to  prepare  to  charge  that  you  are  lacking  in  medical  knowl- 
edge, and  thus  bring  both  justice  and  yourself  to  grief.  Often, 
in  such  cases, 

"Your  enemy  makes  you  wise." 

Firmly  but  courteously  inform  such  agents  that  you  will  not  give 
the  desired  information,  but  that  they  can  elicit  all  you  know  on 
the  witness-stand. 

When  giving  evidence  in  court,  whether  as  plaintiff,  de- 
fendant, or  witness,  endeavor  to  keep  cool  and  self-possessed, 
and  give  your  evidence  with  manly  and  honest  candor ;  guess 
at  nothing,  and  express  no  opinion  for  which  you  cannot  give 
the  why  and  wherefore. 

There  is  no  class  or  profession  other  than  our  own  whose 
members  habitually  confront  and  confute  one  another  in  the 
courts  and  before  the  public.  Our  so-called  psychological 
experts,  specialists,  and  other  would-be  highly  scientific  repre- 


74  THE   PHYSICIAN    HIMSELF: 

sentatives,  have  so  often  been  hired  by  contestants  with  a  view 
to  use  their  dialectic  powers  to  frame  or  elicit  favorable  testi- 
mony, or  the  reverse,  as  the  case  may  require,  in  will,  life- 
insurance,  criminal  cases,  etc.,  that  the  public  are  led  to  freely 
jest  about  tlie  differing  opinions  of  physicians,  and  not  un- 
naturally to  believe,  from  our  lamentable  professional  contradic- 
tions and  divergence  of  opinion,  that  there  is  no  case  so  disrepu- 
table, no  claim  so  monstrous,  that  it  cannot  be  bolstered  up  by 
medical  evidence ;  and  that  our  boasted  science  of  medicine  is 
merely  a  tissue  of  guess-work,  and  that  a  certain  class  of 
pseudo-experts  can  make  things  appear  to  be  either  black, 
white,  or  lead-colored,  and  are  willing  to  sell  testimony  to  the 
highest  bidder,  on  any  side  of  any  question. 

So-called  "medical  experts"  often  excite  disgust  and  indig- 
nation at  the  contemptible  attitudes  they  assume  when  they  act 
against  their  better  knowledge,  and  join  hands  with  mercenary 
and  venal  people  to  attempt  to  mulct  a  physician,  or  to  free  a 
criminal  from  legal  responsibility,  perhaps  to  let  go  a  murderer 
whom  all  the  world  knows  is  guilty,  or  to  condone  other 
scoundrelism  on  the  plea  of  "  insanity,"  "  hypnotism,"  or  im- 
moral pretext  gotten  up  to  make  money,  defeat  justice,  or 
obtain  notoriety — 

"And  help  to  blind  both  judge  and  jury,  not  to  give  them  eyes." 

Never  forget  that  every  principle  of  honor  and  duty  re- 
quires us  to  stand  by  and  defend  each  other  in  everything  that  is 
reasonable  and  just,  and  forbids  us  to  think  of  lending  our- 
self  as  "  medical  cat's-paws,"  either  to  go  on  the  witness-stand  or 
to  prompt  council  in  their  efforts  to  bandy  and  break  down 
medical  witnesses  on  cross-examination,  in  rascally  or  specula- 
tive malpractice  suits  against  reputable  physicians  who  have 
conscientiously  discharged  their  duty  in  cases  of  sickness,  acci- 
dent, or  surgical  operation.  Fractures  about  the  wrist  or  elbow 
furnish  a  large  proportion  of  these  cases ;  eye  cases,  also,  furnish 
another  large  share. 


HIS    REPUTATION    AND    SUCCESS.  75 

These  slanderous  suits  against  physicians  are  generally 
trumped  up  and  entered  either  at  the  instance  of  designing 
physicians  intent  on  the  ruin  of  rival  practitioners,  or  by  un- 
principled, case-hunting,  Champerty  lawyers, — 

"The  words  of  their  mouths  are  smoother  than  butter, 
But  guile  is  in  their  hearts," — 

not  with  the  hope  that  they  may  come  to  trial  on  their  merits, 
but  that  the  accused  physician,  through  natural  dread  of  the 
expense  and  annoyance,  will  pay  a  snug  sum  as  hush  money. 

The  court  records  make  it  appear  that  the  poorer  a  pa- 
tient, and  the  more  that  charity  has  been  exercised,  the  more 
likely  he  is  to  enter  suit  and  otherwise  show  the  basest  ingrati- 
tude. If  ever  a  worthless,  lying  loafer  gets  a  chance  at  your 
pocket-book,  look  out  for  him. 

Probably  there  is  no  department  of  professional  duty  in 
which  physicians  are  asked  to  stretch  their  consciences  so  much 
as  that  of  giving  certificates  that  the  disability  of  persons  seek- 
ing to  get  soldiers'  invalid  pensions  was  contracted  in  the  army. 

It  is  also  possible  that  you  may  be  cajoled  by  friends,  or 
blandished  or  flattered  by  interested  strangers,  or  even  tempted 
by  gold,  to  give  an  opinion  that  old  Jinglecash,  who  was  men- 
tally unfit  to  make  a  will,  was  unclouded  in  mind  and  fully 
competent  to  do  so,  or  that  Mr.  Drinkhard  or  Mrs.  Halfgone, 
with  one  foot  in  the  grave,  the  result  of  intemperance  or  disease, 
is  sound  or  temperate,  and  thereby  to  swindle  an  insurance 
company ;  or  that  Mr.  Badbody  or  Mrs.  Dysoon,  with  a  bias  to- 
ward a  certain  disease  or  with  an  incipient  organic  affection,  is  in 
perfect  health.  Or  Highflyer  or  other  pleasure-loving  officials 
may  seek  to  cover  their  absence  from  duty  by  your  certificate 
that  their  non-attendance  was  due  to  sickness;  or  Mr.  Mak- 
out  may  attempt  through  your  aid  to  escape  military  or  jury 
duty,  or  attendance  at  court  as  a  witness,  or  for  trial,  or  try  to  get 
from  you  a  prescription  for  a  "  Sunday  drink  of  liquor  "  for  the 
thirsty,  under  the  old  pretense  of  "  very  sick." 

Repel  all  such  attempts  promptly  and  decidedly,  and  em- 


76  THE    PHYSICIAN    HIMSELF: 

phatically  refuse  to  be  seduced  from  the  path  of  honor  and  in- 
tegrity, or  to  deviate  from  your  honest  conviction,  for  any  one. 
With  professional  honesty  for  your  pilot,  be  firm  and  un- 
wavering in  your  determination  to  steer  clear  of  practices  and 
alliances  in  which  your  part  would  not  bear  legal  scrutiny 
or  detailing  in  the  community ;  and  you  will  not  only  safely 
pass  the  various  rocks  of  shame  and  whirlpools  of  bitterness 
which  have  wrecked  so  many  of  our  profession,  but  you  will  have 
the  full  approval  of  your  own  conscience.  Perish  all  that  conflicts 
with  the  attainment  of  this. 


CHAPTER  III. 

"  Whatsoever  a  man  soweth,  that  shall  he  also  reap," 

When  you  are  importuned  to  produce  abortion,  on  the  plea 
of  hiding  from  the  world  the  yet-undiscovered  guilt  and  saving 
the  poor  girl's  character,  or  preventing  her  sister's  heart  from 
being  broken,  or  her  father  from  discovering  her  misfortune  and 
committing  murder  or  suicide,  or  him  who  has  taken  criminal 
advantage  of  her  from  being  (sic)  disgraced,  or  to  avert  the 
shame  that  would  fall  on  the  family,  or  the  church  scandal 
about  one  of  the  weak  brethren ;  or,  in  cases  where  there  is  no 
previous  guilt,  to  limit  the  number  of  children  for  married  people 
who  already  have  as  many  as  they  want,  or  who  are  just  married 
and  do  not  want  the  inconvenience  of  them  so  soon,  or  to  ac- 
commodate ladies  who  assert  that  they  are  too  sickly  to  have 
children,  or  that  their  suckling  child  is  too  young  to  be  weaned, 
or  that  they  have  been  pregnant  only  a  short  time,  or  to  avoid 
other  anticipated  evils,  etc.,  etc.,  even  though  it  be  only  the  size 
of  a  mustard  seed,  you  should  not  stop  to  discuss  the  subject 
lengthily  with  a  "  h'm  "  and  a  "  haw,"  but  should  meet  all  such 
entreaties  and  solicitations  with  a  refusal  prompt,  strong,  and 
positive,  and  never  let  yourself  appear  to  entertain  the  proposi- 
tion. If  they  are  too  importunate,  express  your  sentiments  in 
unmistakable  language,  and  with  plain,  American  frankness,  bow 
them  out,  but  remember  that  these  are  terrible  secrets,  and  seal 
your  lips  doubly  tight. 

It  is  always  safe  to  do  right,  and  never  safe  to  do  wrong. 
How  could  any  one  but  an  idiot,  or  an  utterly  unprincipled 
man,  be  induced  to  stain  his  hands  and  his  heart  by  committing 
a  crimson  crime ;  to  violate  both  his  moral  conscience  and  the 
criminal  law ;  to  risk  exposure,  social  disgrace,  and  professional 
ruin  for  himself  and  family,  and  even  the  penitentiary  itself,  by 
taking  the  guilty  burden  from  others'    shoulders  to  his  own, 

(77) 


78  THE   PHYSICIAN    HIMSELF: 

thereby  putting  himself  in  their  shiful  power,  whether  as  a  favor 
or  for  a  paltry  bribe,  or  even  for  all  the  gold  of  California ! 

Evil  rumors  fly  rapidly.  The  production  of  a  very  few 
criminal  abortions  (sometimes  even  a  single  one)  will  surely  go 
from  tongue  to  tongue,  and  give  the  damphool  physician  who 
stoops  to  commit  them  a  widespread  notoriety  as  infamous  and 
as  tenacious  as  the  Bloody  Shirt  of  Nessus.     Take  care 

"That  the  immaculate  whiteness  of  your  fame 
Shall  ne'er  be  sullied  with  one  taint  or  spot." 

A  single  misstep  from  the  heights  of  integrity  may  wreck  one's 
whole  life. 

When  circumstances  render  it  necessary  for  you  to  pre- 
scribe for  females  with  suspended  menses,  where  pregnancy  is 
possibly  or  probably  the  cause,  it  is  better,  instead  of  giving  a 
Latinized  prescription,  to  order  some  simple  thing,  such  as  hop- 
tea,  tincture  of  valerian,  or  wine  of  iron,  under  its  common 
English  name,  with  full  written  instructions  how  to  take  it.  By 
thus  avoiding  all  secrecy  regarding  the  nature  of  the  remedies 
prescribed,  you  will  avert  the  suspicion  or,  may  be,  a  charge  of 
giving  abortifacients. 

To  give  a  woman  who  applies  for  an  abortifacient  an  inert 
agent  would,  to  say  tlie  least,  be  unwise ;  it  is  better  plainly  to 
refuse  to  give  her  anything,  whether  a  pretended  or  real  remedy. 

The  charge  or  suspicion  of  criminal  abortion  is  much  more 
apt  to  be  brought  when  the  woman  is  single  than  when  she  is 
married. 

"  The  physician  must,  like  the  diplomatist,  tread  softly." 

You  must  give  a  cautious,  a  very  cautious  opinion,  if  any,  in 
cases  of  unmarried  females  whose  menses  have  ceased  and  preg- 
nancy is  feared,  or  as  to  whetlier  an  apparent  pregnancy  is  real, 
especially  in  a  case  where  the  suspected  girl,  after  everybody 
else  has  left  the  room,  strenuously  denies  having  had  carnal  in- 
tercourse. Many  will  not  confess  the  trutli  while  a  third  person 
is  present.  Erroneously  to  pronounce  an  honest,  virtuous  woman 
pregnant  may  blast  the  whole  future  life,  honor,  and  innocence 


HIS   REPUTATION    AND    SUCCESS.  79 

of  one  who  was  provided  with  a  shield  of  virtue  and  clothed  in 
the  mantle  of  purity, — 

"A  soul  as  white  as  heaven," — 

and  call  down  maledictions  on  you ;  if,  on  the  other  hand,  and 
on  insufficient  evidence,  you  too  quickly  declare  her  "not  preg- 
nant," or  that  it  is  "  the  dropsy,"  or  "  a  tumor,"  it  might  seriously 
injure  you ;  but  this  mistake  would  bear  no  comparison  to  the 
former,  or  to  the  injury  you  might  inflict  on  an  innocent  person 
by  an  inconsiderate  and  fallacious  opinion.  In  every  instance, 
therefore,  in  which  the  slightest  reasonable  doubt  exists,  tem- 
porize or  suspend  your  opinion  for  weeks,  or  even  montlis  if 
need  be,  till  positively  certain  that  it  is  "  a  kicking  tumor,"  by 
hearing  the  foetal  hemrt-beat  or  feeling  the  fluttering  of  the  child 
within  the  uterus,  or  some  other  unequivocal  sign. 

Unmarried  negresses,  ladies  of  easy  virtue,  and  other  low 
females  (and  sometimes  even  the  wealtliy,  young,  and  beautiful ; 
in  silk,  satin,  velvet,  and  gold),  who  fear  they  are  pregnant,  will 
occasionally  come  to  consult  you,  consume  your  time,  and  get  your 
opinion,  and  when  you  disco \er  that  they  are  really  pregnant, 
and  refuse  to  produce  abortion,  will  try  to  escape  the  payment 
of  your  office  fee.  Where  you  fear  such  injustice,  courteously 
inform  them  at  the  beginning  how  much  your  fee  is  for  your 
time,  opinion,  and  advice,  and  that  it  must  be  paid  whether 
your  recommendation  agrees  with  their  wishes  or  not.  After 
settling  the  fee  question,  study  their  case,  and  candidly  give 
them  your  opinion  and  advice. 

Should  you  ever  encounter  a  case  in  which  you  believe  the 
destruction  of  the  unborn  child  is  (for  physical  reasons)  necessary 
to  save  the  mother's  life,  do  not  consent  to  do  it  secretly,  but 
only  after  regular  consultation  with  some  other  physician  of  well- 
known  probity. 

To  give  directions  for  the  prevention  of  conception ;  or  in- 
structing in  onanism,  buggery,  or  other  nasty  conjugal  sins;  or 
in  the  guilty  use  of  condoms,  sponges,  syringes,  or  preventives 
against  venereal  diseases,  that  encourage  the  timid  to  venture ; 


80  THE    PHYSICIAN    HIMSELF! 

or  in  other  instruments  or  expedients  to  aid  crime  or  to  defeat 
nature ;  though  offenses  beyond  the  reach  of  the  laws,  is,  never- 
theless, most  derogatory  and  degrading  to  the  physician,  and  a 
disgraceful  violation  of  his  professional  office. 

Never  carry  away  or  keep  chloroform,  ergot,  splints,  instru- 
ments, or  other  unused  articles  that  patients  have  paid  for,  with- 
out a  clear  agreement  with  them  to  that  effect ;  and  be  very, 
very  careful  how  you  infringe  upon  the  wine  or  liquor  intended 
for  a  sick  person,  or  eat  his  cake,  fruit,  etc.  Foolishly  to  do 
such  things  would  not  only  lay  you  open  to  criticism,  but  even 
to  the  most  mortifying  charges  of  meanness  or  dishonesty  if  a 
rupture  of  i'riendship  should  ever  occur, — in  fact,  with  such 
things  to  fortify  them,  many  people  would  be  somewhat  dis- 
posed to  welcome  or  create  a  rupture  with  you. 

Be  careful  that  attempts  to  conceal  the  presence  of  con- 
tagious diseases,  or  other  recognized  sources  of  danger  to 
health,  or  of  births  resulting  from  clandestine  marriage,  or  from 
bastardy,  do  not  involve  you  in  the  exposures  and  recriminations 
that  are  apt  to  follow. 

If  you  have  skill  in  avoiding  cases  likely  to  render  your 
attendance  necessary  in  court  as  a  witness  and  other  time-con- 
suming annoyances,  legal  and  social,  it  will  prove  a  source  of 
much  comfort  and  relief. 

Cultivate  agreeable  relations  with  your  professional  neigh- 
bors and  keep  old  friendships  in  repair.  The  practice  of  medi- 
cine isolates  the  members  of  our  profession  from  one  another 
much  more  than  one  would  suppose.  Neighboring  physicians, 
fellow- workers  in  the  same  humane  and  beneficent  profession, 
and  well  known  to  each  other  by  sight  or  reputation,  daily  pass 
and  repass  each  other  without  a  look  or  nod ;  and,  although 
acquaintancesliip  and  social  amenities  might  be  mutually  agree- 
able and  beneficial,  and  possibly  ripen  into  life-long  friendships, 
they  often  remain  as  strangers  for  years,  unless  some  fortuitous 
circumstance  brings  them  together. 

Two  and  two  are  four, — this  is  always  true,  whether  we 


HIS   REPUTATION   AND    SUCCESS.  81 

are  counting  pebbles,  people,  or  planets,  but  it  is  no  more  true 
than  that  every  physician  ultimately  rises  or  falls  to  his  proper 
position  among  his  fellows. 

"Pygmies  are  pygmies  though  perched  on  the  Alps, 
And  pyramids  are  pyramids  in  vales." 

Determine,  therefore,  that  you  will  become  something  more 
than  a  mere  visiter  of  the  sick. 

From  the  very  beginnhig  of  your  career  you  have  social 
and  fraternal  duties,  as  well  as  individual  and  solitary  ones ; 
hence  neither  hold  yourself  aloof  from  the  profession  nor  attempt 
to  isolate  yourself,  and  attend  to  your  own  interests  merely ;  but 
identify  yourself,  head  and  heart,  with  your  medical  brethren  in 
all  legitimate  public  professional  matters :  attend  the  medical 
conventions,  assemblages  of  alumni,  medical  meetings  called  to 
provide  entertainment  for  visiting  medical  celebrities,  memorial 
meetings  held  to  pay  special  tributes  of  respect  to  deceased 
medical  brethren,  general  meetings  of  the  profession,  held  to 
voice  the  opinions  or  policy  of  the  profession  as  a  body,  regard- 
ing public  dangers,  or  to  take  associated  action  on  matters  of 
public  hygiene,  or  regarding  medical  laws  ;  or  to  devise  and  urge 
the  adoption  of  sanitary  measures  against  epidemics,  etc.,  etc. 
Your  presence  at  these  unions  and  reunions  will  keep  you  in 
touch  with  the  profession,  and  be  an  earnest  of  the  spirit  that 
actuates  you. 

Also,  join  the  medical  societies  of  your  neighborhood ;  and 
if  none  exist,  induce  your  medical  brethren  to  join  you  in  found- 
ing one.  Organization  gives  protection  both  to  the  profession 
and  to  individuals.  Society  membership  is  a  guarantee  of  your 
good  standing  and  that  you  pursue  legitimate  practice. 

A  good  medical  society  is  also  something  of  a  post-graduate 
school. 

"  Steel  whets  steel." 

And,  next  to  actual  personal  experience,  there  is  nothing  so 
valuable  to  the  young  practitioner  as  the  medical  society,  for 
there  the  collision  of  mind  with  mind,  and  of   thought  with 


82  THE    PHYSICIAN    HIMSELF: 

thought,  in  amicable  discussion,  awakens  reflection  and  deeper 
reasoning,  increases  the  intellectual  grasp,  stimulates  the  mental 
digestive  power,  and  liberalizes  and  enlarges  the  scope  of  both 
the  speaker  and  the  listener,  and  acts  as  leaven  to  the  entire  pro- 
fession. Nowhere  else  can  you  study  so  well  the  individuality 
and  the  styles  of  different  physicians,  and  discover  the  reasons 
why  each  one  is  what  he  is,  so  fully,  as  at  medical  meetings. 
There  the  specialist,  the  teacher,  the  general  practitioner,  and 
the  book-worm  all  meet, 

"Well  armed  with  mighty  arguments," 

and  each  in  his  own  way  contributes  to  the  instruction  and  in- 
tellectual recreation  of  the  others.  There  you  can  meet  your 
neighbors  on  common  ground,  grasp  each  other  by  the  hand, 
look  into  one  another's  faces,  and  compare  investigations,  experi- 
ence, and  opinion  by  face-to-face  discussion. 

"Many  things,  obscure  to  me  before,  now  clear  up,  and  become  visible." 

There  rivalries,  dissensions,  jealousies,  and  controversies  can 
be  softened,  and  professional  friendsliips  be  formed  and  cemented  ; 
there  you  can  find  opportunities  for  pleasant,  social  intercourse 
with  worthy  men.  There  you  can  also  silently  measure  the 
height  and  depth  of  your  medical  contemporaries,  and  see  the 
difference  between  the  serious  and  the  superficial  tliinker,  the 
convincing  and  the  faulty  logician,  the  judicious  and  the  in- 
judicious, the  alert  and  the  stupid,  intellectual  giants  and  men- 
tal dwarfs  ;  there  you  can  also  estimate  the  influence  of  pleasing 
actions  and  deportment,  and  the  intellectual  and  moral  worth 
of  those  who  command  respect,  and  discover  and  learn  to  avoid 
the  glaring  imperfections  of  others  who  do  not, — and  in  many 
other  respects  learn  effectually  to  separate  the  chaff  from  the 
wheat. 

Medical  societies,  of  course,  are  neither  a  specific  for  all 
personal  deficiencies  nor  a  panacea  for  all  professional  sores. 
There  you  may  find  men  good  enough  ordinarily  to  appear  with 
the  best,  but  weak   enough,  under  temptation,  to  behave  with 


HIS    REPUTATION    AND    SUCCESS,  83 

the  worst ;  some,  too,  who  neglect  all  their  better  duties  under 
the  plea  of  "lack  of  time,"  and  attend  only  when  there  is  to 
be  an  election,  a  feast,  or  a  quarrel.  Spending  a  few  hours 
among  honorable  physicians  once  a  week  will  not  life  Prof  Sin- 
bad  into  angelhood,  change  Dr.  Buffoon  into  a  gentleman,  or 
convert  Dr.  Trickmore  or  Dr.  Quackfrombirth  into  professional 
Chesterfields,  or  lend  Dr.  Oilyone  or  Dr.  Doubleways  consciences 
like  Milton's.  But,  to  repeat :  intercourse  at  a  medical  society 
does  serve  as  an  intellectual  exchange,  where  one  may  hear  the 
discussion  of  moot  points  and  live  questions  in  medicine,  and  at 
the  same  time  establish  with  his  brethren  friendly  and  honorable 
relations.  One  often  sees  distrust  converted  into  friendship 
merely  by  acquaintance. 

Independently  of  the  benefits  and  improvement  accruing 
to  the  members  of  medical  societies  individually,  they  give  a 
sound  and  healthy  tone  to  the  entire  profession,  stimulate  tlie 
growth  of  medical  science,  and  also  generate  and  keep  alive  a 
genuine  professional  and  brotherly  spirit  that  tends  to  minimize 
all  that  is  unprofessional. 

Never  oppose  the  admission  of  any  clean-handed,  honorable, 
and  competent  person  into  society  membership  for  private  or  per- 
sonal reasons,  or  for  any  cause  other  than  ineligibility  or  unfit- 
ness for  the  honors  and  benefits  membership  confers,  because 
such  societies  exist  for  the  advancement  of  medical  and  sursical 
knowledge  and  for  the  benefit  of  all  regular  physicians,  and  it 
would  be  unjust  to  mix  private  feelings  with  professional  duties, 
and  interpose  an  objection  or  a  blackball  on  purely  personal 
grounds. 

Do  not  hesitate  to  take  part  in  the  medical  debates  when- 
ever you  have  anything  valuable  to  ofi"er,  whether  it  is  gleaned 
from  literature,  or  from  the  great  school  of  experience.  If  your 
views  difi"er  from  anotlier's,  express  them  with  courtesy  and 
respect.  If  you  have  a  contribution  or  new  fact  to  offer,  an 
invention,  or  new  pathological  views,  or  a  discovery  or  new 
secret  to  announce,  a  new  instrument  to  show,  an  operation  to 


84  THE    PHYSICIAlSr    HIMSELF*. 

describe,  a  patient  or  specimen  to  present,  a  report  to  make, 
or  a  new  treatment,  a  new  therapeutic  agent,  a  promising  theory 
or  a  talismanic  charm  to  tell  of,  or  anything  whatever  to  say, 
do  it  in  a  careful,  clear,  methodical  manner,  then  sit  down  ;  but 
when  you  have  nothing  worth  offering,  do  not  talk  for  talk's 
sake,  but  make  Ciceronian  silence  your  law,  and  do  not  break 
it.  When  on  the  floor,  take  care  neither  to  abandon  your 
medical  vocabulary  for  the  vernacular,  nor  let  your  professional 
manner  degenerate.  This  will  soon  teach  you  to  arrange  your 
thoughts  quickly  and  to  express  them  clearly. 

Remember  in  debate,  as  elsewhere,  that  there  is  nothing 
infallible ;  that  the  pliysician  must  school  his  prejudices  and  be 
open  to  conviction.  Toleration  of  a  difference  of  opinion  is  a 
lofty  virtue ;  therefore,  say  or  do  nothing  to  wound  the  pride  or 
feelings  of  any  other  member,  and  if  any  incautious  remark, 
misstatement,  or  personal  reflection  drops  from  your  lips,  be  not 
slow  to  make  proper  atonement.  Those  who,  Xero-like,  are 
alwavs  positively  right,  while  all  others  are  positively  wrong; 
who  can  brook  no  opinion  that  does  not  accord  with  their  own, 
are  usually  deemed  hot-headed,  rash,  and  indiscreet,  and  very 
unsafe  guides.  Also,  remember  that  differences  of  opinion  are 
quite  compatible  with  friendship,  and  that  controversies,  discus- 
sions, and  parliamentary  battles,  no  matter  how  sharp  or  ex- 
cited, are  usually  conducted  by  men  of  discretion  within  the 
bounds  of  decorum,  and  without  violations  of  the  ordinary  rules 
of  good  breeding;  and,  also,  that  there  is  no  mode  of  practice 
nor  remedy  for  any  disease  which  has  not  been  the  subject  of 
obstinate  dispute,  and  that  every  great  discovery  or  startling 
announcement  stirs  the  whole  medical  world  to  testing  and 
reporting,  asserting  and  denying. 

You  will  find  that  many  people  entertain  a  belief  that 
medical  societies  exist  for  the  pecuniary  advancement  of  their 
members,  just  as  trades-unions  and  like  organizations  strive  for 
fewer  hours  and  more  pay  for  the  working-classes,  and  that,  in 
some  way  or  other,  they  tend   to  limit  the  freedom  of  personal 


HIS    REPUTATION    AND    SUCCESS.  85 

opinion  and  abridge  the  individual  rights  of  their  members.  Be 
careful  to  correct  such  errors  on  all  suitable  occasions,  and  to 
inform  those  thus  misled  that  medical  societies  exist  not  for 
selfish,  but  mainly  for  scientific,  purposes,  and  the  public  good. 

Keep  up  your  medical  studies,  or  the  knowledge  which 
you  have  already  acquired  will  soon  become  misty  and  ere  long- 
slip  from  your  memory.  Without  more  or  less  continuous 
study  the  details  of  cases  and  the  symptoms  of  many  diseases 
are  apt  to  be  forgotten ;  indeed,  after  two  or  three  years  have 
elapsed,  the  mind  does  not  often  bring  back  the  details  of  par- 
allel cases,  or  of  cases  for  comparison,  unless  they  are  ex- 
tremely uncommon  or  interesting,  and  their  utilization  is  thus 
lost  to  mankind.  Test  your  memory  noAv  by  asking  yourself 
the  following  questions:  What  did  you  have  for  breakfast  on 
the  third  day  of  last  month'?  What  kind  of  a  day  was  the 
ninth  of  last  February  i 

In  consulting  journals  and  text-books,  remember  that 
Y)ractice  found  successful  in  your  own  climate  or  region  is,  as  a 
rule,  more  to  be  relied  upon  locally  than  that  applicable  to  the 
same  disease  in  other  climates.  Also,  avoid  relying  on  anti- 
quated works  on  practice  and  back  volumes  of  journals  as 
guides  in  so  progressive  a  science  as  medicine.  New  investiga- 
tions and  rapid  progress  render  new  text-books  essential  to  those 
who  would  keep  up  with  the  medical  world  and  maintain  the 
skilled  readiness  and  self-reliance  which  the  consciousness  of 
being  fully  posted  on  new  instruments,  methods,  and  improve- 
ments naturally  inspires. 

Endeavor  to  collect  and  form  a  library  of  standard  profes- 
sional works  as  soon  as  possible  after  graduating ;  books  are  the 
tools,  the  literary  apparatus  with  which  we  cut  and  dig  our  way 
to  knowledge,  and  we  now  have  more  books  and  better  books 
than  ever  before.  Money  spent  in  this  way  will  return  a 
hundredfold.  There  is  an  art  in  selecting  material  to  read ;  buy 
the  best  authors  and  always  the  latest  editions,  but  take  care 
that   irrepressible    book-agents,   with  "the    greatest  work  ever 


86  THE    PHYSICIAN    HIMSELF: 

published,"  do  not  induce  you  by  their  importunities  to  sub- 
scribe for  a  jumble  of  books  for  which  you  have  but  little  or  no 
use.  No  one  can  patronize  everything-,  or  even  read  one-tenth 
of  all  that  is  offered,  unless  he  has  nothing  else  to  do.  You 
need  not  be  ashamed  of  a  library  of  twenty  or  thirty  well- 
selected  volumes  of  recent  date,  provided  you  have  thumbed 
them  well,  and  are  lamiliar  with  their  contents ;  and  were  you 
even  to  buy  one  volume  at  a  time  and  study  that  well  before 
ii'ettiu"'  the  next  it  would  be  no  mistake. 

Subscribe  to  one  or  more  medical  journals  and  scientific 
publications,  and  read  and  digest  them  carefully,  so  as  to  keep 
abreast  of  the  discoveries  and  theories  of  the  passing  day.  They 
are  necessary  to  the  progressive  physician.  But  neither  swear 
at  nor  by  all  you  see  in  them ;  be  especially  distrustfid  of  pub- 
lications, edited  by  Dr.  Inkpot  or  Prof  Penn,  that  exist  for  the 
purpose  of  advertising  either  their  owner's  hobby  or  his  goods, 
or  a  college  or  its  clique.  As  a  rule,  you  will  find  that  state- 
ments found  in  the  text-books  and  in  standard  monographs  are 
more  mature,  more  pointed,  and  more  representative  of  collect- 
ive learning,  and,  in  relation  to  therapeutics,  generally  much 
more  reliable  than  those  in  journals,  which  are  often  founded 
on  a  single  case,  or  the  fine-wrought  theories  or  exaggerated 
i'ancy  of  some  unbalanced  rainbow  chaser, 

"Educated  beyond  his  intellect  ;" 

or  the  unconfirmed  experience,  representations,  expectations,  or 
speculations  of  some  partial  observer,  riding  a  hobby  or  pitting 
himself  against  everybody. 

Take  care  to  have  a  good  Dispensatory  and  a  work  on 
Medical  Jurisprudence  among  your  books. 

Acquaint  yourself  fully  with  the  contents  of  your  library, 
so  as  to  be  able  to  refer  to  whatever  you  need  without  hunting ; 
also,  have  one  certain  place  for  every  book. 

Never  allow  yourself  to  be  biased  too  quickly  or  strongly 
in  favor  of  new  or  unsettled  theories,  based  on  physiological, 
microscopical,  chemical,  or  other  experiments,  especially  when 


HIS    REPUTATION    AND    SUCCESS.  87 

offered  by  the  overzealoiis  to  establish  their  own  conclusions  or 
preconceived  ideas,  or  by  those  who  have  identified  themselves 
with  the  latest  medical  novelty. 

Also,  do  not  allow  yourself  to  be  led  too  far  from  the 
practical  branches  of  your  profession  into  histology,  pathology, 
microscopic  anatomy,  refined  diagnostics,  bacteriomania, — 

"Ha!  liu  !  thou,  too,  hust  some  crotchets  iu  thy  head," — 

comparative  anatomy,  biology,  psychology,  the  arrangements 
of  electrical  currents  in  muscular  fibre,  and  analogous  subjects, 
that  merely  interest  or  create  a  fondness  for  the  marvelous  ;  else 
it  will  impair  your  practical  tendency  and  give  your  mind  a 
wrong  bias,  and  your  usefulness  as  a  practicing  physician  will 
almost  surely  diminish.  The  first  question  for  you,  as  a  prac- 
titioner, to  ask  yourself  in  everything  of  this  kind  is.  What  is 
its  use  1 

I  would  not  apply  these  remarks  to  school-men,  or  to  pro- 
fessional teachers  and  experimenters,  who  have  hospital  and 
laboratory  facilities,  and,  perhaps,  wealth  and  leisure,  and  are 
nobly  pursuing  the  higher  reaches  of  purely  scientific  investi- 
gation and  original  thinking  on  borderland  questions,  chiefly  for 
unselfish  love  of  them,  or  to  gain  fame  or  distinction  therein, 
and  become  truly  great; — 

"That  man  is  great,  and  he  alone, 
"Who  serves  a  greatness  not  liis  own;" — 

or  to  others  who,  being  favorably  situated,  are  delving  solely  for 
the  pursuit  of  pleasure,  and  not  looking  to  their  practice  for 
support.  Nor  would  I  dare  say  these  are  not  priceless  kinds 
of  knowledge.  I  mean  to  say  that  skill  in  the  practice  of  med- 
icine does  not  depend  so  much  on  what  the  practitioner  knows 
abstractly  as  what  he  knows  and  has  the  use  of,  and  that  a  per- 
son may  get  so  deeply  absorbed  in  the  hemi-,  demi-,  semi- 
quavers of  the  deep  labyrinths  and  fine  subtleties  of  science  and 
high-thinking  as  to  regard  nothing  but  them,  and  that  your 
most  useful  studies  as  an  eveiy-day  practitioner  will  be  the 
well-ascertained  facts  of  the  profession,  which  are  essential  to 


88  THE   PHYSICIAN    HIMSELF: 

every  skillful  physician :  knowledge  that  relates  to  the  structures 
connected  with  accidents,  operations,  and  surgical  affections, 
and  to  those  of  the  organs  that  are  the  principal  seats  of  medi- 
cal diseases ;  practical  subjects  required  for  the  daily  duties  of 
the  profession,  and,  above  all  else,  the  art  of  treating  diseases 
with  success.  To  know  how  to  relieve  a  colic,  pass  a  catheter, 
or  cure  a  node,  is  a  thousand  times  more  valuable  than  to 
know  that  the  anterior  cornu  of  the  fourth  ventricle  of  the 
brain  runs  a  course  that  is  backward,  outward,  downward,  for- 
ward, and  inward ! 

The  great  popular  test  of  medical  skill  is  curing  the  sick ; 
and  you  will  find  that  your  reputation  will  depend  more  on  the 
successful  treatment  of  your  cases  than  upon  familiarity  with  the 
ultra-scientific ;  and  you  will  meet  physicians,  possessed  of 
comparatively  small  knowledge,  so  dextrous  in  its  use  that  they 
have  done  great  good  in  the  world,  and  ridden  over  the  heads 
of  some  far  better  versed  in  the  books. 

Never,  for  the  sake  of  appearing  in  print,  publish  trifling 
or  hastily  prepared  medical  articles,  as  whatever  one  writes  is 
naturally  supposed  to  be  a  mirror  of  his  own  mind.  Do  not, 
however,  hesitate  to  write  whenever  you  have  anything  valuable 
or  instructive  to  offer,  both  for  the  benefit  of  others  and  to 
enhance  your  own  value,  reputation,  personal  respect,  and 
dignity. 

"Of  all  the  arts  in  which  the  wise  excel, 
Nature's  chief  masterpiece  is,  writing  well." 

All  people  respect  the  man  who  thinks. 

When  possible,  base  your  articles  on  solid  facts,  or  on  an 
analysis  of  facts,  rather  than  on  s])ecidation  and  theory.  Let 
your  diction  be  pure  and  simple,  and  as  short  and  aphoristic  as 
perspicuity  will  allow,  so  as  not  to  weaken  the  effect  of  your 
ideas,  or  obscure  them  in  a  lot  of  long-winded  or  idle  verbiage  ; 
rather  go  straight  to  the  point,  and  make  every  word  count,  in 
expressing  clear,  bright  ideas,  and  let  accuracy  be  characteristic 
of  all  you  write. 


HIS    REPUTATION   AND    SUCCESS.  89 

Be  especially  careful  to  give  your  paper,  essay,  or  book  a 
concise,  appropriate,  and,  as  far  as  possible,  an  attractive  title, — 
one  that  indicates  its  contents,  and  shows  with  sufficient  clear- 
ness the  general  character,  purpose,  and  point  of  the  remarks 
which  are  to  follow. 

"Oh,  liow  that  title  befits  my  composition  !  " 

This  is  essentially  necessary  when  the  title  of  the  work  is  to  be 
put  in  an  index  or  catalogue.  Such  indefinite  titles  as  "  A 
Curious  Case,"  "  Clinical  Communication,"  "  Plain  Facts," — 

"  Bless  us  !  what  a  word  on 
A  title-page  is  this  !  " — 

"  A  New  Method,"  "  A  Case  of  Interest,"  etc.,  furnish  no  clue 
whatever. 

In  writing,  cultivate  perspicuity,  precision,  simplicity,  and 
method  ;  avoid  flaws  of  grammar  or  logic,  and  unmerciful  diffuse- 
ness,  and  do  not  interlard  with  far-fetched,  jaw-breaking  scraps 
and  patches  from  the  dead  or  foreign  languages,  unless  a  trans- 
lation be  appended  ;  for,  unless  it  be  some  time-honored  phrase, 
or  hackneyed  quotation,  the  average  reader  will  probably  be 
forced  either  to  pass  it  over  luisolved,  or  take  down  his  classical 
dictionaries,  dusty  book  of  quotations,  or  his  school-boy  grammar; 
besides: — 

" Every  man  is  not  bred  at  a  'Varsity.'  " 

The  English  language,  the  language  of  Shakespeare,  Milton, 
and  Bacon,  is  of  itself  capable  of  giving  lucid,  eloquent  ex- 
pression to  every  thought  of  man,  and  it  is  to  be  regretted  that 
Fortislingua,  or  any  one  else,  should,  from  superfluous  wisdom, 
or  pedantic  pretension  (Angiographic  aphasia),  fail  to  express 
himself  in  his  own  mother-tongue,  and  make  his  work  brilliantly 
incomprehensible  by  throwing  in  handtuls  of  Latin  and  Greek, 
almost  as  a  cook  peppers  his  broth,  as  if 

"This  writer  has  been  to  a  great  feast  of  languages  and  stolen  all  the  scraps." 

The  recent  attempt  to  supersede  the  old  weights  and  meas- 
ures (which  every  one  understands)  by  the  foreign-looking 
metric  system   did  not  succeed ;  it  is  therefore  scarcely  worth 


90  THE    PHYSICIAN    HIMSELF  I 

while  now  to  discuss  its  merits.  When  you  report  cases  or  pub- 
Ush  anything  in  wliich  weights  are  given,  either  use  the  famiUar 
Enghsh  w^eights  and  measures,  or  give  both  the  old  and  the 
metric ;  to  use  the  French  system  only  savors  of  affectation. 
The  average  reader  makes  no  attempt  to  carry  the  metric  equiv- 
alents in  his  mind,  and  if  you  give  metric  measures  only  he  may 
not  take  the  trouble  to  calculate,  but  pass  your  effusions  by 
without  getting  the  information  you  wish  to  convey. 

Take  notes  of  all  remarkable  cases,  but  do  not  report  or 
publish  any  that  are  not  unique,  or  at  least  tliat  do  not  present 
some  curious,  rare,  or  very  instructive  feature,  or  militate  in 
some  way  against  accepted  theories  ;  otherwise,  you  will  merely 
increase  without  adding  anything  valuable  to  existing  records. 
You  will  find  every  department  of  medical  literature  is  fast 
becoming  loaded  down  with  theoretical  discussions,  speculative 
dissertations,  compilations,  and  word-building;  old,  universally- 
known  things  said  in  a  new  form ;   many 

"An  anxious  blockliead  ignorantlj'^  read. 
With  loads  of  learned  timber  in  his  head," 

seeming  to  say  : — 

"In  pity  spare  me,  while  I  do  my  best 
To  make  as  much  icaste-paper  as  the  rest." 

You  should  omit  book-matter  generally  known,  and  contribute 
original  work,  new  things  rather  than  new  phrases,  new  ideas 
rather  than  new  words.  Use  a  plain,  intelligible  style  ;  do  not 
count  your  words,  but  see  that  every  word  counts;  also,  avoid 
such  ambiguous  descriptions  as  "  the  color  of  an  orange,"  "  tlie 
size  of  a  strawberry,"  "  about  three  inches  long,"  "  about  as 
thick  as  blood,"  etc.;  and  be  as  brief  and  concise  as  justice  to 
your  subject  will  allow,  and,  for  the  poor  printer's  sake,  prepare 
your  matter  so  as  to  please  his  eye  and  require  but  little  or  no 
revision  on  account  of  grammatical  errors,  bad  phraseology,  or 
faidty  style  of  construction. 

When  you  begin  authorship  and  write  books,  essays,  or 
monographs,  use,  for  the  sake  of  convenience,  the  smallest-sized 
sheets  of  white  note-paper,  and  avoid  rolling ;  this  will  enable 


HIS    REPUTATION    AND    SUCCESS.  91 

you  to  keep  them  flat  and  to  handle  them  more  easily  hi  writing, 
altering-,  and  rewriting  pages ;  also,  to  carry  them  to  and  fro, 
and  to  preserve  them  much  better  than  if  large.  If  intended 
for  the  press,  write  only  on  one  side  of  the  sheet,  and  leave  a 
margin  at  the  edge. 

Be  careful,  also,  to  avoid  the  useless  custom  of  appending 
to  your  name  an  excessively  long  list  (like  the  tail  of  a  comet) 
of  all  the  titles  and  alphabetical  appendages  that  you  can  rake 
together,  with  lialf  a  dozen  etceteras ;  such  enumeration  is  in  bad 
taste,  and  tends  to  excite  the  ridicule  of  persons  of  discernment. 
The  chief  use  of  sufiixes  is  that  the  identity  of  the  writer  may 
be  recognized  ;  a  single  suffix,  or  simple  title,  or  the  name  of 
your  town,  street  and  number,  are  unpretentious  and  yet  suf- 
ficiently explicit.  Some  publishing  houses  evidently  think  the 
use  of  titles  by  authors  who  have  reputation  as  writers  aids  the 
sale  of  a  work. 

Never  furnish  a  report,  statement,  or  opinion  on  any  im- 
portant case  or  subject  for  publication,  either  in  book,  journal, 
or  newspaper,  without  a  proviso  that  you  are  to  see,  and  if 
necessary  revise  the  proof,  and  correct  the  printer's  errors  in 
spelling,  punctuation,  etc.,  before  it  goes  to  press ;  otherwise, 
you  may  find  some  purblind  proof-reader  or  go-ahead  printer 
making  you  say  the  reverse  of  what  you  intended,  thus  necessi- 
tating a  long  list  of  "  errata,"  or  may  be  causing  you  to  regret 
that  you  ever  allowed  the  article  to  appear  in  print. 

Do  not  fail  to  pay  your  honest  debts  punctually,  even 
though  you  be  cheated  out  of  lialf  you  earn.  Tlie  best  plan  is 
to  restrict  your  expenditures  to  your  income,  and  pay  as  you 
go,  and  if  you  cannot  pay  much  do  not  go  far  ;  for  to  be  in  debt 
for  horses,  carriages,  horse-feed,  or,  still  worse,  for  dress,  lux- 
uries, rent,  servants'  wages,  etc.,  cannot  fail  to  set  the  tongue 
of  scandal  to  wagging  freely  and  injuriously,  to  the  possible 
ruin  of  your  credit.  Payment  must  be  made  sooner  or  later, 
and  it  is  far  better  to  discharge  each  liability  as  it  becomes  due 
than  to  be  paying  those  that  should  have  been  paid  a  month  or 


92  THE   PHYSICIAN    HIMSELF: 

a  year  ago.  Be  especially  careful  to  keep  your  medical  society 
and  journal  dues  paid  promptly,  and  to  discharge  all  other  pe- 
cuniary obligations.  To  borrow  books,  instruments,  umbrellas, 
money,  etc.,  especially  if  you  keep  them  beyond  the  proper 
time,  or  return  tliem  in  bad  condition,  will  also  tend  to  depre- 
ciate you  more  with  the  lenders  than  you  would  suppose. 
Never  involve  yourself  by  borrowing  any  apparatus,  instru- 
ments, etc,  from  one  physician,  or  patient,  to  lend  to  another; 
if  necessary,  introduce  the  parties  to  each  other,  and  let  the 
borrower  borrow  on  his  own  responsibility. 

It  is  needless  to  say  that  health  and  decency  require  you  to 
guard  against  uncouth,  untidy,  and  repulsive  habits ;  do  not 
pick  your  teeth  or  pare  your  finger-nails,  or  squirt  tobacco- 
juice  around  you  at  your  visits,  or  have  your  breath,  liair,  and 
clothes  as  redolent  as  a  bar-room  spit-box  with  pipe  or  cigar 
fumes,  alcohol,  stale  tobacco,  dead  beer,  etc.,  or  w4th  cloves,  car- 
damom, and  other  masking  aromatics,  or  the  smell  of  iodoform, 
carbolic  acid,  and  other  disgusting  medicines  on  hands  or 
clothes,  or  you  will  unavoidably  prove  obnoxious  and  disgust- 
ing, and  invite  criticism  and  possibly  engender  aversion,  and 
entail  the  loss  of  your  patient.  Coarseness  and  vulgarity  are 
sufficiently  disgusting  in  anybody  and  under  any  circumstances, 
but  in  a  physician,  and  especially  in  the  presence  of  females, 
they  are  unpardonable. 

Avoid  every  habit  that  can  give  reasonable  offense :  to  make 
your  appearance  in  your  shirt-sleeves,  witli  unwashed  hands, 
dirty  finger-nails,  dingy  cuffs,  egg-spotted  or  tobacco-stained 
shirt-bosom ;  greasy  coat,  out  at  elbows ;  ragged  pants,  fly- 
speckled  or  crumpled  hat,  shaggy  whiskers,  or  four  or  five  days' 
beard  on  the  face ;  rough,  creaking,  or  dirty  boots ;  or  with  pipe 
or  stump  of  cigar  in  mouth,  or  chewing  a  quid  of  tobacco; 
or  skylarking,  showing  unseasonable  jocularity ;  using  coarse, 
vulgar,  and  impassioned  language ;  habitual  swearing,  loud 
guffaws,  etc.,  will  by  many  be  regarded  as  evincing  moral  Aveak- 
ness,  and  tend  to  diminish  your  influence  and  prestige,  detract 


HIS    REPUTATION    AND    SUCCESS.  93 

from  your  dignity,  and  greatly  lessen  you  in  public  esteem,  by 
impressing  people  with  the  idea  that,  after  all,  you  are  but  an 
ordinary  person,  and  not  up  to  their  ideal  standard. 

Moreover,  to  be  seen  carpentering,  painting,  or  displaying 
other  common-place  or  out-of-place  talents,  would  also  suggest 
that  your  mind  was  not  engrossed  witli  your  profession.  You 
may  possibly  secure  faith  in  spite  of  these,  but  usually  such 
proclivities  unquestionably  tend  to  decrease  it. 

The  nerves  and  tactile  corpuscles  of  the  tips  of  your  fingers 
will  have  much  to  do  with  your  skill  and  success ;  these  nerves 
are  sometimes  even  superior  to  the  sense  of  sight ;  to  palpate 
the  chest  or  abdomen,  examine  tumors,  make  vaginal  examina- 
tions, do  surgical  work,  etc.,  the  hand  must  be  steady  and  the 
touch  must  be  nice  and  delicate.  If  your  fingers,  instead  of 
having  their  sensibility  protected  and  their  tips  educated,  are 
rendered  callous  and  clumsy  by  manual  labor  or  rough  usage, 
their  delicate  nerves  will  be  unfit  for  these  duties. 

Beware  of  a  certain  temptation  to  which  the  practice  of 
medicine  especially  exposes  you.  The  irregularities,  anxieties, 
and  exhaustions ;  the  cold,  the  wet,  the  hunger,  the  night-work 
and  loss  of  sleep,  and  the  hospitality  of  patients  and  other  friends, 
all  unite  to  tempt  physicians  to  use  alcoholic  stimulants.  Re- 
member that,  although  drunkenness  and  the  idle  life  asso- 
ciated with  it  may  be  tolerated  in  physicians  who  are  fully 
established  in  practice,  because  confidence  and  friendships  had 
been  formed  and  their  talents  and  worth  had  become  known 
previous  to  the  formation  of  the  habit,  it  would  be  fatal  to  any 
one  in  the  formative  stage  of  reputation,  or  just  beginning  to 
gain  the  confidence  of  the  community  ;  for  no  one  who  begins 
life  burdened  with  this  vice  will  be  trusted  or  employed. 
Even  when  the  older  physician,  who  drinks,  is  employed,  it  is 
done  with  loathing,  and  only  to  make  use  of  the  good  half  of 
him,  which  cannot  be  separated  from  the  bad,  and  his  visits  are 
looked  for  by  those  whom  necessity  puts  into  his  hands  with 
disquietude   and  dread. 


94  THE    PHYSICIAN    HIMSELF  I 

AVhat  is  a  more  disgusting  spectacle  than  a  drunken,  swear- 
ing, reckless  sot-of-a  physician,  with  whisky-soaked  breath, 
staggering  around  the  bed  of  a  sick  or  dying  person,  profan- 
ing the  occasion  by  the  thoughts  he  excites,  and  by  his  gross- 
ncssl  The  wisest  policy  for  you  personally  is  to  avoid 
intoxicating  drinks,  which  cause  so  much  crime,  sickness,  and 
poverty,  and  allow  others  to  do  as  they  think  best.  The  cause  of 
drunkenness  is  drinking,  and  if  you  are  foolish  enough  to  drhik 
liquor,  wine,  or  beer  when  people  offer  it  to  you,  you  not  only 
run  the  risk  of  getting  fond  of  it,  but  nine  chances  to  one  tliose 
very  people  Avill  be  the  first  to  add  the  charge  that  "he  drinks'* 
whenever  any  other  person  says  anytliing  else  against  you ;  but 
when  it  becomes  known  that  you  never  touch  the  demon  it  will 
be  of  immense  advantage  to  your  reputation.  But  intemperately 
to  urge  puritanical  ball-and-chain  temperance  on  others,  or  being 
an  officious  member  of  temperance,  secret,  or  beneficial  societies, 
will  aid  you  but  little  if  any  in  tlie  acquirement  of  practice, — 
the  most  desirable  class  of  which  is  the  quiet  family  business 
that  you  will  attract  by  a  faithful  and  kindly  endeavor  to  do 
your  very  best  for  all  who  apply  for  your  services  as  a 
physician. 

A  physician's  life,  like  a  pantomime,  is  full  of  wonderful 
changes,  and,  being  a  public  character,  lie  knows  not  the  day 
he  may  need  the  friendship  or  good  offices  of  this,  that,  or  the 
other  person  toward  wliom  he  may  have  felt,  and  unwisely 
shown,  political,  or  religious,  or  personal  hostility;  therefore, 
do  not  allow  yourself  to  grow  morbid  on  temperance,  total 
abstinence,  local  option,  prohibition,  and  other  sumptuary  cru- 
sades, partisan  strifes,  and  puerile  contentions ;  as  they  will  be 
apt  to  recoil  on  your  head  if  you  make  yourself  prominent  in 
them.  If  your  office  is  located  very  much  nearer  the  cliurcli 
than  the  tavern,  and  if  you  lean  to  tlie  Sabbatarian  element  in- 
stead of  the  pitfalls  of  infidelity  and  atheism,  so  much  the  better; 
but  proselyting  and  pushing  matters  of  a  partisan,  political, 
radical,  or  secular  nature  is  not  your  function,  and  you  cannot 


HIS   REPUTATION    AND    SUCCESS.  95 

become  officious  in  them  and  their  irritating  methods  without 
setting  (about)  one-half  of  the  community  against  you,  and 
exciting  enmity,  and  maybe  personal  liostility.  You  had, 
therefore,  better  leave  all  subjects  for  discord,  heart-burnings, 
animosities,  and  angry  discussion,  whether  political  or  religious, 
to  the  general  public,  unless  your  pecuniary  or  social  position  is 
such  that  you  can  very  well  afford  to  run  the  risk,  or  are  driven 
to  do  so  by  conscientious  scruples  that  outweigh  all  other  con- 
siderations ;  and  even  then  it  is  better  to  let  your  profession 
occupy  the  dominant  place  and  your  patients  be  your  first  and 
principal  care. 

AY  hen  requested  to  write  a  prescription  to  enable  an  ailing 
person,  who  really  needs  it,  to  procure  liquor  on  Sunday  or  in  a 
local-option  district,  comply  with  becoming  good  nature,  but 
accept  no  fee  for  it. 

Presents  from  fond  or  grateful,  very  liberal  or  romantically 
generous  patients,  although  flattering,  will  almost  invariably 
lead  to  the  disarrangement,  if  not  actual  rupture,  of  the  legiti- 
mate pecuniary  relations  previously  existing  between  yourself 
and  the  giver,  which  it  may  consequently  be  impossible  fully  to 
re-establish. 

"In  the  long  run,  gifts  are  often  losses." 

Most  practitioners  can  probably  recall  instances  in  which  presents 
of  knee-blankets,  whips,  baskets  of  game  or  fruit,  boxes  of  cigars, 
wine,  pet  animals,  canes,  free  passes,  gloves,  new  hats,  curiosi- 
ties, baby-named-for-you,  etc.,  have  spoiled  their  bill,  and  proved 
not  only  unprofitable,  but  exceedingly  expensive.  When  you 
foresee  such  a  result,  be  guarded. 

You  will  find  it  a  good  rule  to  decline  all  presents  and 
favors  that  are  likely  to  place  you  under  embarrassing  obliga- 
tions to  patients,  A  still  more  important  rule  is  to  avoid  mixed 
dealings  and  crossed  accounts  witli  careless  hucksters,  grocers, 
feed-men,  milk-men,  and  other  patients,  as  such  dealing  will 
rarely  continue  to  be  satisfactory;  they  often  lead  to  dis- 
agreements, and  in  "  squaring-up "  will  almost  always  result  in 


96  THE    PHYSICIAN    HIMSELF: 

your  getting  only  about  half  as  much  for  your  services  as  if  you 
had  avoided  entanglements.  It  is  decidedly  better  to  conduct 
your  affiiirs  upon  strictly  business  principles,  i.e.,  let  those  for 
whom  you  work  pay  you  in  money,  you  in  turn  doing  the  same. 
In  a  word,  you  had  better  avoid  everything  that  tends  to  efface 
your  business  rules. 

Preserve  a  proper  degree  of  gravity  and  dignity  toward 
patients.  Frivolous  conduct,  vulgar  jokes,  horse-play,  clownish 
levity,  unseasonable  sportiveness, — 

"I  love  to  laugh,  though  Care  stands  frowning  by, 
And  pale  Misfortune  rolls  her  meagre  eye," — 

and  bar-room  familiarity  are  unprofessional,  and  tend  to  breed 
contempt  and  scandal.  Discourage  all  attempts  of  roughs  and 
toughs  to  rudely  address  you  with  a  "  Hallo,  Doc !"  or  by  your 
first  name,  or  in  any  way  to  pass  the  limit  of  propriety  with  you. 
Show  every  one  proper  respect,  and  exact  the  same  in  return. 
Do  not,  however,  understand  me  to  advocate  solemn  pomposity, 
or  to  condemn  good-natured  pleasantry.  Not  so  ;  for,  when  gen- 
tlemanly and  in  moderation,  it  is  often  very  appropriate,  and 
sometimes  actually  serves  as  a  tonic  to  a  patient's  drooping  spirits. 
If  you,  happily,  possess  a  becoming  earnestness  of  deportment, 
and  at  the  same  time  wear  a  cheerful  mien,  it  will  be  health  to 
yourself  and  sunshine  to  your  patients. 

Avoid  dining  out  with  your  patients  and  attending  their 
tea  or  card  parties.  Eat  as  seldom  as  possible  at  their  houses, — 
only  when  unavoidably  detained  there  by  cases  of  labor,  con- 
vulsions, and  tlie  like.  There  is  a  tendency  to  conviviality  and 
abandon  around  the  festive  board  that  has  a  leveling  effect,  and 
divests  the  physician  of  his  legitimate  prestige.  It  is  far  better 
to  eat  a  cold  repast  at  home  than  to  occupy  the  best  seat  at  the 
table  and  partake  of  the  most  savory  viands  of  some  patients. 
Let  a  physician  once  unbend  himself  among  a  certain  class  of 
people,  and  he  risks  a  complete  loss  of  their  professional  appre- 
ciation and  regard. 

When  compelled  by  circumstances  to  accept  a  meal,  if  you 


HIS   REPUTATION    AND    SUCCESS.  97 

chance  to  be  served  alone,  so  much  the  better ;  if  seated  to  eat 
with  the  family,  be  courteous,  but  somewhat  reserved,  and 
exliibit  no  uncalled-for  levity,  but  simply  endeavor  to  render 
yourself  agreeable.  Shun  all  badinage  and  gossip  and  undue 
extolling  of  the  viands,  and  be  careful  to  make  no  after  allusions 
elsewhere  to  the  "  snowy  cloth,"  the  "  delicious  butter,"  the 
"juicy  beefsteak,"  etc.,  as  though  you  were  a  stranger  to  these. 

Try  to  give  satisfaction  at  your  visits ;  show  that  you  are 
anxious  to  relieve  both  the  body  and  the  mind  of  your  patient, 
and  you  will  not,  can  not,  fail  to  succeed  in  your  ambition  to  get 
practice.  To  do  this  fully  you  must,  of  course,  feel  and  express 
a  genuine  interest  in  the  case  and  in  the  effects  of  the  remedies 
you  are  employing.  Bear  in  mind,  also,  that,  with  any  prac- 
titioner, the  first  essential  to  success  is  that  he  should  command 
the  confidence  of  his  patients. 

When  necessary  to  scold  or  find  fault  with  your  patients  or 
their  attendants  (as  is  often  the  case),  either  preface  or  follow 
what  you  say  by  explaining  that  you  are  not  scolding  in  anger^ 
but  because  you  feel  an  earnest  desire  to  have  tliem  do  right  for 
their  own  and  others'  sake.  By  thus  prefacing  your  reproof  you 
will  completely  disarm  resentment,  and,  no  matter  how  severe, 
all  you  say  will  be  taken  in  good  part. 

If  you  are  unmarried,  it  will,  no  doubt,  be  often  cited 
against  you ;  but  the  truth  is,  there  is  no  great  professional  ad- 
vantage gained  by  simply  being  married.  The  objection  to 
most  unmarried  physicians  is  really  not  their  celibacy,  but  their 
youthfulness,  which  may  also  be  quoted  against  you  even  if 
married.  It  is  true  that  the  conversation  and  society  of  intelli- 
gent and  virtuous  females  impart  self-respect  to  man,  and  give 
elegance  and  tone  to  his  manners ;  and  for  him  to  feel  that  the 
inspiring  eye  of  such  a  one  is  upon  him  often  inflames  his  soul 
with  ambition  to  reach  the  highest  goal  and  to  win  the  greenest 
laurels.  It  is  also  true  that "  it  is  not  good  for  man  to  be  alone," 
and  that  every  physician  should,  when  his  pecuniary  circum- 
stances justify  the  step,  look   out  for  a  wise  helpmate,  settle 


98     •  THE    PHYSICIAN    HIMSELF: 

down,  and  make  for  himself  a  home ;  but  to  marry  with  an  eye 
to  business  only  would  be  a  very  imprudent  step,  and  entail 
expenses  and  responsibilities  without  corresponding  benefits. 
Besides,  you  should  keep  both  business  and  marriage  on  a  higher 
plane. 

"  Without  hearts  there  is  but  little  home,  and  less  happiness." 

You  will,  in  your  professional  career,  often  witness  the  misery, 
cares,  and  anxieties  that  flow  from  degrading  the  tender,  half- 
human,  half-divine  bonds  of  marriage  by  entering  into  it  simply 
to  gratify  lust,  to  obtain  money,  or  from  other  ill-regulated  pas- 
sions, or  from  any  other  considerations  whatever  than  pure  love 
and  congeniality  of  souls,  and  you  had  better  seek  no  friend 
this  side  of  heaven  than  risk  the  formation  of  the  wrong  kind 
of  domestic  relations  yourself. 

Everybody  wants  a  lucky,  conservative  medical  attendant, — 

"Many  funerals  discredit  a  physician," — 

therefore,  a  series  of  dystocias,  or  of  deaths  in  childbed,  or  of 
unsuccessful  surgical  operations,  or  of  malignant  cases,  or  cases 
of  any  kind  that  have  terminated  unsatisfactorily,  often  injuri- 
ously affect  the  physician  for  years  by  attaching  to  him — es- 
pecially if  he  be  a  beginner — either  charges  of  being  blind  to 
danger  and  to  duty,  or  a  long-to-he-reinemhered  reputation  for 
bad  luck.  If  such  a  series  unfortunately  threatens  you  in  the 
beginning  of  your  practice,  seek  to  strengthen  yourself  by  con- 
sultations with  able  brethren. 

No  one  can  succeed  fully  without  the  favorable  opinion  of 
the  gentle  maids  and  acute  matrons  with  whom  he  may  be  asso- 
ciated in  the  sick-room.  They  can  be  his  best  friends  or  his 
worst  enemies.  AVomen  and  cliildren  constitute  four-fifths  of 
all  the  population.  Females  have  more  sickness  than  males, 
and  the  females  of  every  family  are  the  autocrats  of  the  sick- 
room, and  have  a  potent  voice  in  selecting  the  flimily  physician. 
I  have  sometimes  thought  that  the  real  secret  why  so  many  truly 
scientific  physicians — to  whom  a  patient  is  an  object  of  scientific 
interest,  just  as  a  rock  is  to  a  geologist,  or  as  a  flower  is  to  a 


HIS    REPUTATION    AND    SUCCESS.  99 

botanist,  who,  more  naturalists  than  physicians,  love  the  rays  of 
philosophy  and  the  beams  of"  science  better  than  humanity ;  and 
with  their  eye  at  the  end  of  the  microscope,  watch  cases  merely 
from  a  scientific  point  of  view,  or  to  study  the  action  of 
medicine — very  often  decidedly  lack  popularity,  and  fail  to  get 
much  practice,  is  that  cold,  unemotional,  impassive  logic  and 
high  theoretical  attainments,  however  much  admired  abstractly, 
are  not  a  certain  guarantee  of  popular  favor,  since  they  are  often 
attained  at  the  expense  of  the  endearing  sentiments,  and  hence 
create  none  of  those  friendly  ties  upon  which  getting  practice 
partly  depends;  but,  on  the  contrary,  are  often  associated  with 
a  deficiency  of  the  qualities  of  head  and  heart  which  appeal  to 
the  weak  side  of  woman — Iter  emotions — and  gain  her  favoring 
opinions,  and  secure  her  good  will  and  word. 

The  power  to  impress  those  you  meet  with  a  favorable 
opinion  of  your  adaptation  to  your  calling  is  a  potent  and 
important  factor.  Discipline  yourself  by  rigid  self-examination 
whenever  you  have  conducted  yourself  unsatisfactorily.  This 
will  teach  you  to  conceal  or  eradicate  your  defects  and  faults, 
and  to  give  prominence  to  your  good  qualities. 

The  faculty  of  being  able  to  please,  and  thereby  make 
friends  of  those  who  employ  you  in  an  emergency  or  tenta- 
tively, is  likewise  a  power  that  you  should  carefully  cultivate. 

You  will  find,  also,  that  remembrance  of  the  names  of 
children  and  of  patients  whom  you  see  but  rarely,  and  the 
ability  to  recall  the  salient  points  of  former  interviews  with 
them,  gives  you  a  reputation  for  a  good  memory,  and  is  a  very 
useful  adjunct  to  other  qualities. 

Three-fourths  of  all  the  population  are  children ;  and  their 
likes  and  dislikes  will  control  your  destiny  in  many  a  family. 
Many  people  patronize  various  forms  of  quackery  for  no  better 
reason  than  that  "the  children  take  it  easily,"  knowing  from 
experience  that  an  attempt  to  give  pills  or  bitter  doses  to  refrac- 
tory children  who  dislike  compulsion,  or  spoilt  children  with 
resolute  wills,  whose  nurses  and  mothers  have  taug-ht  them  to 


100  THE    PHYSICIAN    HIMSELF  I 

look  on  "  the  doctor  "  as  a  barbarian  or  butcher,  means  a  fight 
and  a  failure. 

In  your  efforts  to  estabhsh  a  practice  you  must  not  rely 
strongly  on  friendship  or  social  influence,  for  men  are  influenced 
by  self-interest,  and  your  truest  friends  and  acquaintances  who 
knew  you  when  you  were  a  boy  may  prefer  that  you  test  your 
skill  and  gain  your  experience  by  attendance  on  others  rather 
than  on  them  or  theirs. 

Socially,  you  may  be  a  great  favorite  while  all  are  well ; 
but  when  sickness  occurs  and  death  threatens,  the  principle 
of  self-interest  arises,  and  the  impulses  of  friendship  and 
kindred  become  dormant  and  do  not  determine  the  choice  of 
of  a  physician.  Xo  member  of  any  family  circle  will  be  spared, 
if  any  human  power  can  save,  and  thouglitful  persons,  terrified 
at  the  possibility  of  losing  the  kind,  provident  husband,  the 
beloved  wife,  blooming  daughter,  darling  babe,  dutiful  son,  or 
honored  parent,  as  the  case  may  be,  instinctively  send  for  the 
physician  in  whose  skill  they  have  most  confidence.  They  go 
past  Dr.  Newstart,  about  whom  they  know  too  little ;  past  Dr. 
Drinker,  whose  system  requires  so  much  stimulating,  about 
whom  they  know  too  much;  past  Dr.  Gay,  Dr.  Fickle,  Dr.  Aim- 
less, Dr.  Butterfly,  Dr.  Misfit,  Dr.  Strangeways,  Dr.  Blackleg,  Dr. 
Phunnyman,  Professor  Halfsmart,  and  all  others  whose  \mpro- 
fessional  demeanor  proves  them  to  be  either  unripe  or  unsuited 
to  duties  so  delicate,  so  precious,  so  weighty  as  that  of  a  family 
physician, — past  all,  till  they  reach  Dr.  Standbest,  in  whom  their 
faith,  their  medical  confidence,  centres.  Faith  is  the  great  con- 
trolling guide  in  choosing  him  who  is  to  stand  by  what  may 
be  one's  death-bed  or  the  death-bed  of  one's  loved  ones.  The 
greatest  two  elements  of  medical  faith  are :  first,  a  belief  on  the 
part  of  the  patient  that  you  are  anxious  to  do  the  best  that  can 
be  done  for  him ;  second,  that  you  are  not  only  willing,  but 
know  how. 

Be  courteous  and  considerate  to  every  one,  especially  when 
you  are  vexed  or  in  a  hurry ;  discourteous  abruptness  in  phy- 


HIS   REPUTATION    AND    SUCCESS.  101 

sicians  inflicts  many  useless  wounds,  some  of  wliich  are  difficult 
to  heal.  Politeness  and  courtesy  are  seed  that  cost  nothing, 
can  he.  planted  anywhere,  that  always  bear  good  fruit, — fruit 
that  never  withers.  Resolve  that  you  will  cultivate  them  as 
long  as  you  live. 

When  boys  or  young  men  come  to  you  for  assistance  for 
their  base-ball  clubs,  or  their  library,  and  the  like,  give  some- 
thing, and  give  it  freely.  If  ladies  ask  you  for  a  donation  to  aid 
the  heathen  (! ! !)  or  to  help  buy  a  carpet  for  their  church,  for 
the  relief  of  some  one  afflicted,  or  any  other  laudable  object, 
give  willingly  and  cheerfully.  If  the  tiny  boy  or  girl  comes  to 
sell  a  concert  or  other  ticket,  buy  it  laughingly;  for  contributions 
of  this  sort  not  only  do  good  to  others,  but  often  prove  to  be  a 
judicious  professional  investment  for  self  Were  you  to  scowl 
and,  with  lengthened  phiz,  say  "  no  ! !  "  the  young  man  and 
woman  and  the  tiny  boy  would  all  unite  in  calling  you  "  old 
stingy,"  and  ever  after  avoid  you. 

There  is  a  significant  fact  which  you  might  not  observe 
without  having  your  attention  called  to  it ;  it  is  that,  after  you 
get  into  full  practice,  your  days,  weeks,  months,  and  years  will 
flit  by  faster  than  those  of  other  people,  like  the  mists  of  the  morn- 
ing, because,  as  a  physician,  you  will  be  incessantly  engrossed 
with  a  medley  of  important  absorbing  cases,  with  the  nature  of 
your  occupation  constantly  changing,  and  the  flight  of  your 
time  will  consequently  be  almost  magical. 

You,  yourself,  are  mortal ;  therefore,  you  should  not  only  try 
to  prolong  your  life,  but  to  get  as  much  out  of  it  as  you  can,  by 
seeking  proper  relaxations  and  amusements  while  the  age  for 
enjoying  them  remains  : — 

"As  we  journey  through  life, 
Let  us  live  by  the  way." 

Many  physicians,  in  the  eager  pursuit  of  business,  foolishly 
postpone  all  relaxation  from  one  time  to  anotiier,  intending  to 
give  up  some  of  the  hardest  of  their  work  and  worst  of  their 
privations,  and  to  fall  back  on  their  reiautation   for  skill  and 


102  THE    PHYSICIAN    HIMSELF  I 

experience,  and  then  to  take  life  easier,  indulge  in  diversions, 
social  amenities,  and  pleasure,  when  they  get  older, — in  the 
autumn  of  life, — when  the  hair  grows  gray,  etc.,  forgetting 
that 

"An  unlaid  egg  is  an  uncertain  thing," 

and  thus  unwisely  neglect  to  seek  enjoyments  till  they  lose  all 
taste  for  them,  till  they  know  nothing,  and  are  fit  for  nothing 
but 

"Work  !     Work  ! !     Work  !  !  1 " 

and  to  wear  out  their  lives  in  routine  toil  and  drudgery  daily  and 
nightly,  as  the  slave  of  the  sick  public,  on  the  rough,  hard,  joy- 
less treadmill  of  practice,  hurrying  up-stairs,  down-stairs,  from 
one  sick-room  to  another,  from  some  horrible  sight  to  a  stinking 
case,  a  death-bed,  or  a  dangerous  amputation,  and  from  that  to 
a  repulsive  obstetric  case,  or  a  puking  baby,  or  some  other  kind 
of  patient,  weak,  petulant,  or  exacting ;  often  summoned  un- 
necessarily, too,  at  unseasonable  hours,  or  bored  at  home  with 
office  patients ;  then  pouring  over  books  and  thinking  day  and 
nisht,  till,  from  Ion o-con tinned  and  extraordinarv  mental  and 
physical  exertions,  they  become  prime  candidates  for  one  or  the 
other  of  the  physician's  two  afflictions, — organic  heart  disease 
or  atheroma  of  the  cerebral  arteries, — then  progressive  heart- 
failure  or  apoplexy;  next — death,  as  the  penalty. 

A  little  leisure,  either  to  rest  or  to  play,  or  rational  amuse- 
ment of  any  kind,  soothes  the  troubled  waters  of  professional 
life,  and  is  a  great  blessing, — rec-reation  is  re-creation.  Make  it 
your  rule  to  do  as  little  work  on  Sundays  and  holidays  as  is  con- 
sistent wdth  your  duty  to  others,  and  do  not  hold  consultations 
on  Sunday,  except  in  cases  of  urgent  necessity.  The  Sabbath, 
or  day  of  rest,  was  instituted  in  Paradise,  by  God  himself,  and 
is  a  blessing  to  all.  It  is  asserted  that  violating  The  Gospel  of 
Rest,  and  working  seven  days  in  a  week,  instead  of  resting  the 
tired  brain,  shattered  nerves,  and  fatigued  limbs  on  the  seventh, 
shortens  a  life  of  three-score  and  ten  by  twenty  years.  I  know 
a  busy  physician  who,  to  protect  himself,  has  a  sign  in  his  office 


HIS    REPUTATION    AND    SUCCESS.  103 

saying  "No  Office  Hours  on  Sunday,"  An  occasional  day's 
sport  with  rod  or  gun,  or  a  summer  trip,  or  an  evening  at  a 
convivial  meeting,  or  at  the  theatre,  a  change  of  occupation,  or 
alternation  of  labor  with  ease  of  any  kind,  will  work  off  nervous- 
ness and  act  as  a  refresliment  to  your  labors;  break  the  worries, 
frets,  tumults,  jarring,  and  cares  of  practice;  vary  the  monotony 
of  life,  subdue  mental  tension,  remove  brain-weariness,  soften 
the  ups  and  downs,  soothe  mental  excitement  and  nervous 
strain,  conduce  to  health  and  longevity,  and  actually  make  you 
more  philosophical  and  a  better  physician. 

The  cost  of  a  pleasure  trip  or  a  few  days'  recreation  is  not, 
however,  to  be  counted  by  tlie  expense  of  your  journey  only, 
but  you  must  also  add  the  far  heavier  loss  in  practice,  and  the 
unmerited  blame  that  is  apt  to  follow  being  absent  from  those 
who  need  you. 

Newspaper  notices  of  your  departure  from  the  city  for 
short  sea-side,  mountain,  or  other  brief  pleasure  trips  will,  if  al- 
lowed, have  a  disturbing  and  hurtful  influence  on  your  practice 
while  you  are  away,  and  even  after  your  return.  Reporters  are 
aware  how  such  items  injure  physicians,  and  seldom  publish 
them  unless  requested.  The  register-clerk  of  hotels  where  you 
register  will,  if  asked  to  do  so,  omit  announcing  your  arrival  in 
the  newspapers,  which  would  publish  your  brief  absence  from 
business  to  the  whole  world. 

If  a  professional  friend  is  prevented  from  attending  to  his^ 
practice  by  sickness,  or  even  by  sickness  or  death  in  his  family, 
it  is  just  and  proper  to  attend  to  practice  for  him  without  re- 
ward ;  but,  if  one  goes  in  quest  of  pleasure  and  amusement,  it 
is  proper  and  just  for  him  adequately  to  remunerate  you  or 
whomever  else  he  gets  to  do  his  work. 

When  you  get  another  to  do  your  work,  it  will  be  much 
less  laborious  for  him  if  you  have  your  office  patients  sent 
from  your  office  to  his,  instead  of  compelling  him  to  spend 
or  waste  your  stated  office  hours  at  your  office ;  also,  to  have 
your  family  send  each  new  call  to  him  when  received,  instead 


104  THE   PHYSICIAN    HIMSELF  I 

of  compelling  him  to  call  again  and  again  to  learn  whether  he 
is  needed. 

.  After  prolonged  absence  from  home  or  recovery  from  long 
sickness,  it  is  wise  and  perfectly  ethical  to  announce  the  fact  of 

your  return  to  practice  through  the  newspapers:  "Dr.  , 

No.  —  Street,  has  returned  from  his  vacation  (or  recovered  from 
his  sickness),  and  will  resume  his  practice  immediately."  Further 
than  this  keep  your  name  out  of  the  newspapers,  and  leave 
medical  self-advertising  to  physicians  who  prefer  to  quack! 
quack!  quack!  and  to  rival  pill-mongers. 

Merchants  and  tradesmen  attract  customers  by  handbills 
and  newspapers,  and  yet,  even  though  they  do  exaggerate,  such 
methods  are  not  considered  dishonest,  because  their  customers 
are  supposed  to  know  something  of  the  prices  and  quality  of 
the  articles  offered;  besides,  they  can  go  from  dealer  to  dealer, 
to  examine  and  compare  before  buying;  but  with  quacking 
physicians  the  stranger  has  no  such  opportunity,  no  such  safe- 
guard ;  because  their  ads.  and  puffs  tell  only  one-half  of 
the  story, — cures  and  successes, — and  studiously  omit  the  other 
half, — failures  to  cure  and  cases  made  worse, — and,  since 
strangers  allured  to  physicians  by  them  can  neither  compare 
their  skill,  weigh  their  pretenses,  nor  gauge  their  honesty,  all 
such  resorts  are  deemed  ethically  wrong. 

When  you  assume  charge  of  a  case  for  another  physician, 
to  look  after  during  his  sickness  or  absence  from  the  city,  or  one 
of  your  own  that  has  been  under  the  care  of  a  substitute  while 
you  were  away,  or  that  any  one  has  attended  in  an  emergency 
pending  your  arrival,  take  care  to  do  as  much  good  as  possible 
for  the  patient,  with  as  little  harm  as  possible  to  the  former  at- 
tendant ;  continue  his  line  of  treatment,  at  least  for  awhile,  if 
you  can  conscientiously  do  so.  An  abrupt,  radical  change, 
either  in  diagnosis,  prognosis,  or  treatment,  or  designedly  dif- 
fering with  him,  either  in  opinion  or  practice,  is  both  ungener- 
ous and  injurious  to  your  co-worker.  In  such  a  case,  if  you 
believe  something  more  should  be  given,  instead  of  stopping  his 


HIS   REPUTATION    AND    SUCCESS.  105 

red  or  black  medicine  and  ordering  a  white  or  yellow  one,  or 
his  pills  or  capsules,  and  ordering  tablets  or  powders,  merely 
add  yours  to  what  is  already  being  done,  and  thus  avoid 
unpleasant  reflections. 


CHAPTER  IV. 

"The  first  step  to  wisdom  is  to  be  exempt  from  folly." 

Always  entertain  and  show  respect  for  your  seniors  in 
practice.  There  is  probably  no  type  of  medical  man  more 
unworthy  than  coxcombical  young  Dr.  Knowaheap,  who  over- 
estimates himself,  and  considers  that  he  is  the  most  learned 
person  in  the  profession ;  underestimates  his  seniors,  and  shows 
a  corresponding  contempt  for  them.  Being  fresh  from  college, 
and  medicine  being  a  progressive  science,  he  may  excel  the 
older  physicians  in  the  use  of  the  microscope,  the  stethoscope, 
and  other  severely  scientific  and  technical  points ;  but  long 
experience  has  been  their  additional  teacher,  and  they  have  a 
progressive  clinical  acquaintance  with  disease  which  gives  an 
intuitive  perception  as  to  the  choice  of  remedies,  and  in  general 
makes  them  better  logicians  and  much  better  practitioners ; 
because  there  are  peculiarities  which  belong  to  almost  every 
disease,  about  which  there  is  little  or  nothing  to  be  learned 
from  the  books ;  and  knowledge  and  skill  derived  from  obser- 
vation and  experience  far  outweigh  mere  college  learning, 
book  knowledge,  and  specific  formulas,  to  be  learned  by  rote 
and  applied  by  routine ;  and  are  more  like  part  of  one's  very 
nature  than  that  gotten  from  any  other  source,  and  are  fixed 
indelibly  on  both  one's  senses  and  reason,  to  be  brought  forth 
again  when  needed.  Remember,  too,  that  although  young 
physicians  have  recourse  to  scientific  "  extras,"  fine-drawn  dis- 
tinctions, and  modern  instrumental  aids  to  diagnosis,  and  the 
very  latest  in  treatment,  more  than  do  the  older  ones,  yet  in 
relying  on  these  too  much  and  on  rational  subjective  symp- 
toms and  common  methods,  and  especially  on  the  unaided  eye, 
too  little,  they  are  apt  to  forget  the  fact  that  the  best  part  of 
every  man's  knowledge  is  that  which  he  has  acquired  for  him- 
self, and  that  the  art  of  curing  disease  owes  more  to  sound 
(106) 


HIS   REFUTATION    AND    SUCCESS.  107 

judgment  and  common-sense  bedside  observation  and  experi- 
ence than  to  anytliing  else. 

True,  the  practitioner  who  has  grown  gray  and  wrinkled 
in  the  profession  is  more  apt  to  disregard  the  nicer  pathological 
diagnosis,  which  defines  the  technical  variety  of  the  disease, — 
whether,  for  instance,  a  pneumonia  is  catarrhal,  croupous,  or 
interstitial, — and  to  be  more  attentive  to  the  therapeutical  diag- 
nosis which  indicates  what  the  treatment  should  be ;  weighing 
the  influence  of  age,  season,  rate  of  progress,  complications, 
secondary  affections,  compensatory  changes,  and  other  clinical 
phenomena  with  a  nicety  that  the  junior  with  all  his  brains  can 
never  acquire  from  his  text-books  or  in  the  lecture-room,  and 
then,  as  with  intuitive  wisdom  determining  as  to  the  best  reme- 
dies for  the  mental  and  bodily  sufferings  of  the  patient  before 
him, — reducing,  evacuating,  quieting,  stimulating,  or  feeding 
him  as  foresight  and  experience  have  taught.  The  reputation 
of  every  physician  is  twofold, — one  portion  earned  by  himself, 
the  other  acquired  from  the  general  respectability  and  reputa- 
tion of  the  profession,  and  public  confidence  in  it ;  and  such 
men — white-bearded  or  bald-headed  or  furrow-cheeked  thouofh 
they  may  be — have  done  very  much  to  give  our  profession  this 
honorable  standing,  and  to  smooth  the  way  for  others,  and 
hence  are  certainly  worthy  of  all  respect. 

On  the  other  hand,  the  older  physicians,  having  had  their 
turn,  and  remembering  the  rough  and  difficult  trials,  the  painful 
responsibilities,  exhausting  toils,  and  heart-rending  doubts  and 
anxieties  and  ill-treatments,  and  the  blunders  and  sufferings 
and  dearly-bought  lessons  of  their  own  beginning,  should  show 
favor  to  their  younger  brothers  without  fear,  and  work  side  by 
side,  with  friendly  feelings ;  for  no  matter  how  many  aspirants 
appear,  there  is  always  enough  work  left  for  the  older  physician 
who  has  done  his  duty  in  the  community ;  yea !  the  world  is 
wide  enough,  and  there  is  sickness  and  misery  enough  in  it  to 
keep  every  worthy  hand  and  head  and  heart  employed ! 

Life  is  a  school  for  all.     When  you  have  been  in  practice 


108  THE   PHYSICIAN    HIMSELF  I 

long  enough  to  cultivate  observation  and  to  acquire  an  address 
in  the  management  of  the  sick  and  to  impress  your  patients  with 
the  fact  that  you  have  good  common  sense  in  everything  and 
uncommonly  good  sense  in  medicine ;  have  accurate  judgment, 
and  evolve  practical  wisdom  out  of  your  own  brain  ;  and  that 
you  know  the  duty  of  a  physician  in  their  sickness,  and,  in 
addition,  are  especially  conversant  with  their  moral  and  physi- 
cal idiosyncrasies,  such  impressions  will  be  of  great  advantage  to 
you,  and  will  make  professional  attention  to  them  much  easier. 

"He  knows  the  water  best  who  has  waded  through  it." 

You  will  occasionally  be  employed  in  cases  because  you 
have  long  ago  attended  other  members  of  the  family  in  similar 
affections,  and  are  very  naturally  supposed  to  know  the  peculi- 
arities of  their  blood,  and  to  understand  the  various  points  in 
the  family  constitution, — their  temperament  and  hereditary  ten- 
dencies and  predispositions, — and  to  possess  sovereign  remedies 
for  their  relief. 

You  will  find  that  the  belief  that  you  understand  this  or 
that  person's  constitution  from  brain  to  toe,  from  surface  rind  to 
innermost  core,  and  know  exactly  what  they  require  within  and 
without,  their  likes  and  dislikes,  is  a  powerful  advantage, — one 
that  gives  you  unusual  prestige  and  a  favorable  chance  to  show 
your  skill  and  to  give  them  a  still  greater  confidence. 

Experience  and  skill  are  what  the  public  especially  seek  in 
a  physician  ;  they  are  truly  important,  and  everybody  knows  it. 
You  should  carefully  try  to  show  that  you  possess  both.  Of 
course,  we  all  have  aftersight,  but  far-seeing,  prognostic  fore- 
sight, and  ability  to  correctly  comprehend  all  the  changes  that 
have  taken  place  between  your  medical  visits,  is  what  is  needed. 
This  is  not  described  in  your  text-books,  or  furnished  by  lec- 
tures, but  is  sure  to  come  from  practical,  dear-bought  experience 
in  diagnosing  and  combating  diseases,  and  will  develop  and 
improve  your  jtidgment  in  every  way,  and  enable  you  each  year 
to  see  more  fully  into  the  very  essence  of  your  cases,  and  to 


HIS   REPUTATION    AND    SUCCESS.  109 

foresee  their  events  with  increased  clearness;  and  if  you  compel 
yourself  to  work  faithfully  and  to  develop  the  faculty  of  observa- 
tion, every  year  will  make  you  a  better  physician,  and  by  tlie 
time  you  have  worked  and  observed  for  ten  or  twelve  years  you 
will  have  attained  the  calmness  of  wisdom,  and  become  clini- 
cally familiar  with  the  symptoms  and  events  of  all  the  more 
common  afflictions  that  confront  us,  and  you  will  then  know  far 
better  than  now  how  to  wave  the  ^sculapian  wand,  liow  to 
avoid  former  errors  and  mistakes,  and  also  more  easily  and 
more  exactly  to  shape  your  diagnosis,  prognosis,  and  treatment 
in  each. 

In  addition  to  the  great  advantage  the  older  physicians 
have  over  the  younger  ones,  from  increased  ability  to  discern 
the  true  nature  and  to  foresee  the  probable  degree  and  dura- 
tion of  grave  and  critical  cases,  and  to  give,  concerning  them, 
more  discreet,  definite,  and  truer  opinions  from  the  beginning, 
they  can  also,  from  experience,  recognize  and  point  out  cases  that 
are  doubtful  or  likely  to  prove  slow  and  tedious ;  they  also  have 
more  staid  judgment,  and  give  better  cautions  and  more  solid 
precepts,  and  thereby  relieve  themselves  of  much  anxiety  and 
risk  of  blame.  Such  advantages  naturally  enhance  their  repu- 
tation, and  enable  tbem  to  reap  the  full  value  of  their  skill; 
give  them  a  better  address  and  greater  confidence  in  themselves, 
and  enable  them  to  treat  serious  and  tedious  patients  with  steadi- 
ness, and,  meanwhile,  to  retain  confidence  much  better  and  much 
longer  than  younger  physicians.  This  is  the  chief  reason  why 
physicians,  sharpened  by  long  practice,  are  less  harassed  in  dif- 
ficult cases  by  meddling  officiousness  from  outsiders,  and  either 
dismissed  or  forced  to  call  in  a  consultant,  than  younger  ones, 
and  why  the  practice  of  medicine  becomes  relatively  easier 
and  lighter  every  year.  You  will  find  that  after  you  have  prac- 
ticed twelve  or  fifteen  years ;  after  many  of  the  fine  precepts, 
beautiful  descriptions,  and  nice  distinctions  gotten  from  the  pro- 
fessors at  college  have  taken  wings ;  after  you  have  forgotten 
much  of  your  theoretical  Text-Book  knowledge, — which  was 


110  THE   PHYSICIAN    HIMSELF! 

probably  greater  comparatively  at  graduation  than  it  will  ever  be 
again, — your  experience  will  give  you  an  immense  storehouse  of 
practical  facts  that  will  be  invaluable  to  you,  and  will  often  serve 
you  in  cases  in  which  book-learning  cannot ;  indeed,  it  is  impos- 
sible to  obtain  from  books  alone  sufficient  knowledge  of  disease 
to  make  you  a  good  practitioner.  The  possession  of  self-attained 
post-graduate  knowledge  gathered  from  tlie  great  book  of  Na- 
ture will  make  it  appear  to  those  around  tliat  you  know  what 
to  do  and  how  to  do  it,  and  is  the  kind  that  will  make  the 
public  prefer  you  to  your  younger,  less-experienced  brother. 

The  public  love  to  see  a  physician  appear  to  understand  his 
business  fully  and  to  discover  the  actual  condition  at  a  glance,  or 
to  know  things  intuitively;  therefore,  you  must  study  and  practice 
to  be  quick  in  diagnosis,  and  ever  ready  in  the  treatment  of  the 
common  diseases  and  ordinary  emergencies  that  will  probably 
constitute  nine-tenths  of  your  practice. 

Study  carefully  the  laws  of  prognosis  and  probable  dura- 
tion of  disease,  for  it  is  in  these  that  young  physicians  are  most 
deficient.  Errors  of  prognosis  are  ordinarily  far  more  damag- 
ing to  the  physician  than  errors  of  diagnosis  and  of  treatment. 
Very  few  people  can  discover  whetlier  or  not  your  diagnosis  and 
treatment  are  correct,  or  otherwise  judge  tlie  truth  of  your  as- 
sertions or  the  justice  of  your  reasoning ;  but  if  you  say  a  pa- 
tient will  recover  and  he  dies,  or  that  he  will  die  and  he  gets 
well,  or  that  he  will  be  sick  a  month  and  yet  he  gets  up  in  three 
days,  or  that  he  will  be  well  in  three  days  and  yet  he  is  sick  a 
month,  everybody  will  see  that  you  are  wrong,  and  will  very 
naturally  infer  that,  as  you  were  wrong  in  your  prognosis,  your 
diagnosis  and  treatment  may  have  been  equally  so,  and  they 
will  naturally  seek  some  one  else  with  more  experience  and 
keener  foresight. 

Skill  in  these  things  will  enable  you  to  foretell  a  favorable, 
a  doubtful,  or  a  fatal  termination,  and  to  foreknow  the  duration 
in  a  greatly  increased  proportion  of  your  cases  and  save  you  a 
vast  amount  of  anxiety. 


HIS   REPUTATION    AND    SUCCESS.  Ill 

In  forming  your  prognosis  use  all  five  of  your  senses,  if 
necessary ;  and  be  careful  to  ascertain  not  only  the  condition  of 
the  organ  chiefly  aftected,  but  of  the  other  vital  organs  also, 
since  their  condition  and  action  may,  in  some  degree,  compen- 
sate for  the  lost  or  impaired  functions  of  the  diseased  organ. 
Look  also  at  the  surroundings  of  your  patient,  and  the  nursing 
and  attention  he  can  command ;  and,  lastly,  learn  to  estimate, 
from  the  look,  the  voice,  the  groan,  the  cry,  the  breathing,  the 
conlplexion,  the  gesture,  and  general  aspect, — mental  and  physi- 
cal,— his  vital  resistance  to  the  disease  (which  differs  in  each 
individual),  and  then  form  your  prognosis. 

Bear  this  in  mind :  In  your  desire  to  soothe  the  fears  of 
anxious  relatives,  do  not  wrong  yourself  in  serious  cases  by  pro- 
nouncing them  lighter  or  less  dangerous  than  they  really  are. 
Such  mistakes  often  bring  us  sorrow  and  cause  blame.  The 
little  pleurisy  or  the  slight  gastritis  of  to-day  may  be  something- 
greater  to-morrow. 

Never  ask,  as  you  enter  to  pay  the  first  visit  to  a  patient, 
the  apparently  simple,  yet  awkward,  question,  "  What  is  the 
matter  with  you  1  "  or  salute  him  at  any  other  visit  with  "  How 
are  you  to-day  1  "  or  he  will  probably  retort  that  is  exactly  what 
he  wants  you,  the  physician,  to  tell  him. 

Do  not  display  the  fact  that  you  are  a  junior  or  a  tyro  work- 
ing by  reflected  light,  and  thereby  belittle  yourself  in  the  esti- 
mation of  patients,  by  constantly  quoting  what  this  or  that  man's 
book  says,  or  what  such-and-such  a  medical  celebrity  thinks,  or, 
worse  still,  by  taking  down  your  text-books  before  tliem,  to 
learn  what  they  say ;  as  if  you  were  deficient  in  readiness  or  in 
nerve,  or  had  to  rely  on  the  opinions  of  others  for  all  you  know. 

Also,  never  carry  a  ready-written  prescription  to  a  patient, 
as  if  copied  from  somebody  else's  book  ;  rather  commit  it  to 
memory,  or  jot  it  down  in  your  visiting-list,  to  be  glanced  at  and 
written  off  at  the  proper  time. 

The  folly  of  blindly  accepting  or  slavishly  following  the 
dicta  of  this  or  that  master  is  nicely  depicted  by  Moliere  in 


112      '  THE   PHYSICIAN    HIMSELF: 

L' Amour  Medecin,  Acte  ii,  Scene  2,  where  the  following  dia- 
logue occurs  between  Dr.  Tomes  and  Lisette : — 

Tomes. — How  is  the  coachman  1 

Lisette. — He  is  dead. 

Tomes. — Dead  % 

Lisette. — Yes. 

Tomes. — That  is  impossible. 

Lisette. — It  may  be  impossible,  but  it  is  so. 

Tomes. — He  cannot  be  dead,  I  say. 

Lisette. — I  tell  you  he  is  dead  and  buried. 

Tomes. — You  are  mistaken. 

Lisette. — I  saw  it. 

Tomes. — It  is  impossible.  Hippocrates  says  that  such  dis- 
eases do  not  terminate  till  the  fourteenth  or  twenty-first  day,  and 
it  is  only  six  days  since  he  was  taken  sick. 

Lisette. — Hippocrates  may  say  what  he  pleases,  but  the 
coachman  is  dead. 

Take  a  lesson  from  this,  and,  if  you  have  no  experience  of 
your  own  to  guide  you,  adopt  that  of  otiiers ;  but  remember  that 
your  patients  of  all  shades,  white  and  black,  rich  and  poor,  want 
to  know  what  you  think,  and  care  but  little  for  high-sounding 
names,  or  for  what  you  have  read  in  Hippocrates,  Watson, 
Gross,  or  been  told  in  lectures  by  your  preceptor. 

If  you  are  determined  to  let  people  know  you  are  inexperi- 
enced and  have  no  opinion  of  your  own,  you  should  at  least 
spare  them  the  infliction  of  following  you  to  the  sources  from, 
and  through  the  processes  by,  which  your  borrowed  opinions 
were  obtained.  If  one  is  invited  to  dinner,  he  may  imagine  his 
host  does  not  prepare  it  all  himself,  but  he  does  not  care  to  be 
taken  down  into  the  kitchen  and  through  the  pantries,  and 
shown  the  pots  and  pans  and  rolling-pins,  and  to  be  introduced 
to  the  cooks  and  waiters,  all  to  let  him  know  exactly  how  the 
feast  is  prepared.  One  will  feel  much  better  entertained  if  he  is, 
at  the  proper  time,  simply  introduced  to  the  table,  smoking  and 
groaning  with  its  bounteous  supply. 


HIS    REPUTATION    AND    SUCCESS.  113 

Remember  this  :  Every  one  likes  to  believe  that  the  phy- 
sician is  treating  him  by  a  regular  plan  rather  than  firing  at 
random,  more  especially  in  diseases  that  are  believed  to  depend 
on  the  blood  or  on  any  peculiar  diathesis. 

Make  post-mortem  examinations  and  scientific  use  of 
your  opportunities,  to  confirm  or  correct  your  diagnosis  and  to 
become  more  familiar  with  the  machinery  of  life,  whenever  fit- 
ting cases  or  questions  as  to  the  cause  of  death  from  unknown 
complaints  present  themselves ;  but  never  allow  the  inference 
that  you  are  cutting  or  mangling  the  bodies  of  the  dead  to 
gratify  idle  curiosity  ;  or  to  satisfy  yourself  alone,  or  to  show 
that  your  feelings  and  emotions  have  passed  through  a  process 
of  hardening,  or  that  it  is  a  very  great  favor  to  be  allowed  to 
do  it ;  but  put  it  rather  and  emphatically  on  the  higher  ground 
that  it  is  done  for  the  benefit  of  science  and  in  the  interest  of 
suffering  humanity,  and  that  it  may  be  for  the  good  of  the  very 
persons  with  whom  you  are  then  talking. 

In  making  autopsies  in  private  families  never  hurry,  but 
take  time  and  do  them  thoroughly,  and  be  doubly  careful  to 
avoid  unnecessary  mutilation,  and  let  your  neatness  and  man- 
ner evince  the  greatest  respect  for  their  sleeping  dead,  and 
due  regard  to  the  feelings  of  those  around,  more  especially  if  a 
promiscuous  audience,  or  non-professional  persons,  are  present, 
and,  after  concluding,  hide  all  traces  of  your  work  as  fully  as 
possible,  and  then  compare  what  you  have  discovered  with  your 
view  of  the  case  before  death. 

Bear  in  mind  that  all  civilized  and  all  savage  nations  re- 
spect the  dead,  and  that  the  important  uses  of  the  dead  to  the 
living  are  the  only,  but  all-sufficient,  justification  for  human 
dissection. 

Also,  that  it  is  morally  and  ethically  wrong  to  consent  to 
make  a  post-mortem  examination  of  any  one  who  has  died 
under  the  care  of  a  brother  physician,  at  the  solicitation  of 
persons  who,  with  mischief  in  their  hearts,  seek  to  disprove  the 
diagnosis  and  disgrace  the  medical  attendant ;  also,  that  when 


114  THE    PHYSICIAN    HIMSELF: 

making  autopsies,  even  in  cases  of  accident  or  sudden  death,  the 
deceased  person's  regular  medical  attendant  should,  if  possible, 
be  invited  to  be  present. 

Out  of  respect  to  both  the  dead  and  the  living,  defer 
making  post-mortem  examinations  for  a  few  hours  after  death, 
if  possible ;  as  the  hypostatic  congestion  that  naturally  fol- 
lows death  is  often  mistaken  by  the  public  for  ante-mortem 
changes,  and  gives  rise  to  the  most  wonderful  stories  of  "  a 
murder,"  "  only  in  a  trance,"  etc.  It  will  always  be  well  to 
point  out  to  them  its  true  nature  and  cause,  and  its  utter  lack 
of  significance. 

The  useless  and  unjustifiable  repetition  of  physiological 
and  pathological  experiments,  made  to  illustrate  already  known 
facts,  that  require  vivisection  of  animals  is,  by  many,  called 
cruel  sport,  and  has  received  popular  opprobrium,  and  will  not 
add  much  to  your  reputation,  if  done  with  that  in  view,  as  such 
things  are  supposed  to  have  been  studied  as  far  as  needful  in  the 
laboratory  and  dissecting-room  before  leaving  college.  On  the 
contrary,  making  clinical  analyses  of  the  urine  and  other  fluids 
as  an  aid  to  diagnosis  will  not  only  lead  to  invaluable  informa- 
tion regarding  your  patient's  condition,  but  will  be  a  great 
element  in  giving  you  popularity  and  professional  respect. 

Working  with  the  microscope  on  proper  occasions  will  not 
only  increase  your  knowledge,  but  will  also  invest  you,  in  the 
eyes  of  the  public,  with  the  benefits  of  a  scientific  reputation 
and  its  attendant  advantages. 

Obstetrical  practice  is  undoubtedly,  in  some  respects,  desir- 
able, especially  in  the  beginning  of  professional  life,  as  each  case 
partakes  somewhat  of  the  nature  of  a  battle  in  which  the  ac- 
coucheur is  (thanks  to  Providence)  nineteen  times  in  twenty  victo- 
rious, and  his  services  are  appreciated  and  extolled,  and  in  future 
relied  on,  which  gives  hiin  a  retaining  hold  upon  that  patient, 
and  paves  the  way  to  other  permanent  family  practice.  The 
inevitable  and  wearisome  ivalting  at  the  bedside,  however,  en- 
tails a  serious  loss  of  time.     Chance  calls  of  any  kind  you  can 


HIS    REPUTATION    AND    SUCCESS.  115 

take  or  not  at  your  discretion,  but  specific  engagements,  es- 
pecially in  obstetric  cases,  must  be  kept,  day  or  nigbt. 

Should  you  ever  get  so  overburdened  with  work  that  time 
is  doubly  precious  with  you,  attending  many  obstetrical  cases 
will  so  overtax  your  powers  tliat  it  may  become  actually  neces- 
sary, in  self-defense,  to  restrict  or  withdraw  from  these  and 
other  time-consuming  engagements,  in  order  that  you  may  get 
time  to  breathe  and  to  attend  to  the  rest  of  your  patients  with 
something  like  regularity,  and  to  obtain  your  meals,  sleep,  etc., 
and  do  your  writing  and  studying.  Midwifery  is  a  wearing 
and  exhausting  branch  of  medicine, — the  hardest  kind  of  hard 
work, — and  in  filth  but  little  superior  to  the  Nightman's;  it 
seriously  interferes  witli  regular,  healthy  living,  and  is  fvdl 
of  care  and  responsibility ;  and,  although  it  does  lead  to  other 
family  practice,  you  will  find,  after  some  years,  that  the  ordinary 
fees  for  attending  cases  of  confinement  are,  on  account  of 
trouble,  and  anxiety  while  absent  from  them  before  or  during- 
labor,  loss  of  time  in  waiting  and  consequent  interference  witli 
the  fulfillment  of  other  duties  and  engagements,  together  with 
the  nights  of  work,  after  days  of  toil,  loss  of  sleep,  risk  of 
breaking  down,  etc.,  which  they  occasion,  proportionately  more 
meagre  than  in  any  other  department  of  practice. 

If  you  keep  a  daily  record,  you  will  probably  find  that  nine- 
tenths  of  all  your  loss  of  rest  is  due  to  obstetrical  cases. 

When  a  woman  engages  you  to  attend  her  in  confinement, 
write  her  name  and  address  on  one  of  your  cards  and  hand  it  to 
her,  with  instructions  to  send  it  to  you  as  soon  as  she  feels  that 
your  services  are  likely  to  be  required.  This  will  empliasize 
the  engagement,  serve  to  remind  her  of  the  mutual  obligation 
or  contract,  and  make  her  more  apt,  when  her  time  comes,  to 
call  you  in  than  to  call  another  physician,  or  to  get  a  midwife 
with  a  view  to  save  expense. 

In  spite  of  your  having  been  engaged  to  attend  a  case,  and 
being  kept  in  suspense  for  weeks  or  months,  you  will  sometimes 
learn  that  the  confinement  is  over,  tliat  a  midwife  or  granny  was 


116  THE   PHYSICIAN    HIMSELF: 

sent  for,  and  the  excuse  will  be  that  everything  occurred  in  such 
a  hurry  that  they  could  not  wait  for  you,  or  had  no  messenger 
to  send,  or  some  other  equally  lame  plea. 

You  will  often  be  called  upon  in  bad  cases  to  do  ugly  work 
for  midwives  who  have  reached  the  limit  of  their  obstetric  knowl- 
edge, and  for  the  sufferer's  sake  you  should  never  refuse  to  go  and 
assume  charge  of  the  case.  Such  occasions  will  afford  you 
valuable  opportunities  to 

"Do  two  hours'  work  in  forty  minutes," 

and  to  show  the  practical  superiority  of  qualified  physicians  over 
the  unskilled  midwiie  and  unpractised  irregular,  and  also  to  en- 
hance your  position  in  the  estimation  of  the  public. 

Pregnant  women  will  sometimes  want  to  make  an  Indian 
bargain  with  you  beforehand,  to  come  to  them  only  in  case  their 
midwife  fails.  Of  course,  you  should  go  to  all  cases  where  hu- 
manity calls,  but  you  should  hardly  bargain  with  anybody  before- 
liand  to  play  second  part  to  a  midwife, — she  to  take  the  fee  and 
eclat^  if  there  is  no  trouble ;  you  to  take  the  care  and  responsi- 
bility for  a  nominal  fee,  if  there  is.  You  may  be  surprised  to 
learn  that  it  is  now  generally  understood  in  many  communities 
that  every  midwife  has  her  regular  medical  referee  to  assist  her 
in  her  complicated  cases, — a  one-sided  bargain,  which  gives  her 
the  unearned  ecJat^  if  there  is  any,  and  him  an  undue  proportion 
<of  worrying  cases  of  tedious  labor. 

When  you  first  visit  a  woman  in  labor  it  is  a  wise  rule  to 
•ask  her,  among  other  questions,  whetlier  she  has  felt  the  motions 
of  the  child  since  labor  began,  that,  in  case  she  has  not,  and  it 
is  born  dead,  you  may  have  some  evidence  that  it  was  dead 
before  you  arrived,  if  such  is  truly  the  case.  Also,  if  your  ex- 
amination of  a  primipara  shows  very  unusual  smallness  of  the 
vaginal  orifice,  incidentally  mention  the  fact,  and  tell  of  the  pos- 
sibility of  laceration  of  the  perineum,  that  you  may  not  be 
unjustly  blamed  if  that  should  unavoidably  occur. 

In  every  primipara  case  of  confinement,  after  delivering 
the  child,  be  careful  to  call  the  mother's  attention  to  the  lum^ 


HIS    REPUTATION    AND    SUCCESS.  117 

in  her  abdomen,  and  inform  her  that  it  is  only  tlie  contracted 
womb.  If  you  omit  to  do  so,  she  may  accidentally  discover  it, 
get  greatly  alarmed,  and  either  await  your  visit  with  dread,  or 
send  for  you  post-haste.  . 

The  enlarged,  pouched,  or  protuberant  abdomen,  that  be- 
gins in  many  females  a  few  months  or  years  after  confinement, 
believed  by  them  to  be  enlargement  of  the  womb  caused  by  not 
])eing  properly  bandaged  after  labor,  is  due  to  adipose  tissue 
accumulating  in  the  omentum  and  in  the  abdominal  walls,  and 
also  encumbering  the  abdominal  viscera. 

Attendance  on  patients  at  long  distances  has  a  tendency  to 
derange  and  diminisli  your  nearer  practice,  for  while  absent 
attending  a  remote  call  you  may  lose  three  nearer  ones.  Nor 
do  distant  visits,  as  a  rule,  pay  in  a  pecuniary  sense,  but  they 
do  work  an  injustice  to  both  physician  and  patient.  Every  one 
should  have  a  family  physician  within  reasonable  calling  dis- 
tance. A  few  far-off  patients  will  waste  more  time,  break  down 
more  horseflesh,  use  up  more  carriages,  harass  you  at  unseason- 
able hours,  keep  you  from  bed,  and  expose  you  to  bad  weather 
more,  and  do  more  to  make  your  life  a  hard  one  than  all  your 
other  practice  combined. 

Keep  your  practice  down  to  a  number  that  you  can  prop- 
erly attend  ;  you  can  do  this  by  sending  in  your  bills  promptly, 
weeding  out  worthless  patients,  circumscribing  your  field  of 
practice,  declining  other  than  desirable  obstetrical  engagements, 
increasing  your  cliarges,  etc.  In  refusing  to  take  a  case  at  a 
distance,  or  one  that  is  likely  to  involve  you  as  a  witness  in 
(;ourt  contrary  to  your  wish,  or  to  accept  an  obstetric  engage- 
ment, if  you  are  really  "  too  busi/,^'  assign  that  as  your  chief 
reason,  as  it  is  the  least  open  to  criticism  and  persuasibility  of 
any  that  can  be  assigned. 

Never  offer  as  an  excuse  for  neglect  in  visiting  a  patient, 
"  I  really  forgot  you ; "  to  forget  the  sick  is  unpardonable. 

Gonorrhoeal  and  syphilitic  cases  are  not  very  desirable  on 
any  account,  except  for  the  fees  they  bring ;  they  are  dirty. 


118  THE   PHYSICIAN    HIMSELF: 

secret  cases,  and  rather  repel  than  attract  their  victims  and  their 
friends  to  the  physician  who  attends  them  when  they  require  a 
pliysician  for  other  diseases.  Accepting  them  will,  however, 
often  enable  you  to  pick  up  a  handsome  cash  office-fee. 

Even  when  you  are  positive  that  a  person  has  syphilis,  it 
is  not  always  judicious  to  say  so. 

"All  truth  is  not  to  be  told  at  all  times." 

Prudence  will  sometimes  require  you  to  reserve  your  opinion, 
but  at  the  same  time  take  care  to  give  the  proper  treatment. 
Indeed,  in  practicing  your  profession,  you  will  see  and  under- 
stand the  results  of  many  sinful  habits  and  vicious  courses  to 
which  you  must  appear  more  or  less  bhnd. 

Be  careful  that  your  reputation  for  special  interest  in 
venereal  diseases  does  not  oversliadow  or  ecUpse  other  kinds, 
and  give  you  the  unenviable  title  of  "  P — x  Doctor,"  and  entail 
the  social  ostracism  and  loss  of  genteel  family  practice  that 
Avould  surely  follow ; — or  that  extra  success  in  restoring  the 
menses  in  females  who  suspect  pregnancy  does  not  bring  an 
extra  number  of  such  cases  to  consult  you,  and  give  you  the 
title  of  "  Abortionist ; " — or  that  attending  an  excessive  propor- 
tion of  sporting,  courtezan,  and  bruiser  classes  does  not  give 
you  the  undesirable  notoriety  of  having  a  "  fancy  practice  ;  " — 
or,  again,  that  perpetual  and  indiscriminate  inquiring  about  the 
lu'ine,  and  having  it  bottled  for  you  (urology),  does  not  earn  for 
you  the  easily  acquired  title  of  "  P — ss  Doctor  ;  "  — 

"  Four  lovely  berries  moulded  on  one  stem;  " — 

or  that  a  liver  hobby,  or  a  kidney  hobby ;  or  that  the  womb,  or 
the  stomach,  does  not  become  with  you  a  scapegoat  to  be 
blamed  for  every  obscure  disease,  give  you  the  title  of  "  crazy- 
ologist,"  and  thus  eventually  impair  your  usefulness  and  harm 
your  position  as  a  practitioner. 

You  will  iind  it  much  more  pleasant  and  satisfactory  to  at- 
tend in  some  families  than  in  others.  From  some  you  will  con- 
stantly receive  intelligent  co-operation,  and  they  will  make 
charitable  allowance  for  any  little  failure  or  shortcoming,  while 


HIS    REPUTATION    AND    SUCCESS.  119 

from  others  you  will  experience  the  reverse,  and  it  will  seem  as 
it'  they  want  to  perplex  and  harass  you  in  every  conceivable 
way,  and  as  if  they  would  make  you  feel,  in  attending  them, 
that  you  were  on  trial  for  your  life. 

It  is  this  harassment  and  continued  feeling  of  personal  in- 
volvement and  perpetual  anxiety,  quite  as  much  as  overwork, 
that  wears  down  the  health  and  shortens  the  life  of  the  phy- 
sician. Bear  this  in  mind,  and  let  it  be  your  philosophic  rule 
and  determination  never  unnecessarily  to  worry  about  anything 
you  cannot  help  or  avoid. 

You  cannot  be  too  guarded  in  asking  private  questions, 
especially  about  diseases  of  an  immodest  nature,  before  people 
not  in  the  confidence  of  the  patient,  unless  they  are  clearly  en- 
titled to  hear  them  ;  in  such  case,  request  all,  and  particularly 
those  of  the  opposite  sex,  to  leave  the  room  before  putting  the 
questions.  Be  doubly  cautious  in  this  respect  when  your  pa- 
tient is  a  female,  and  the  questions  refer  to  marriage,  men- 
struation, pregnancy,  lactation,  uterine  affections,  constipation, 
urinary  derangements,  or  other  delicate  subjects,  that  her  confi- 
dential secrets  may  not  be  exposed,  or  her  modesty  ofiended. 

You  will  find  it  judicious  also  to  avoid  inquiring  of  a  pa- 
tient in  stores  or  barber-shops,  or  on  the  street  or  other  public 
places,  in  the  presence  of  strangers,  about  his  ailments,  or  those 
of  patients  at  his  liome,  unless  they  can  be  referred  to  without 
the  slightest  impropriety.  Many  persons  are  very  sensitive  in 
reference  to  their  complaints  and  weaknesses,  and  captious 
concerning  the  time,  place,  and  manner  of  asking  about  them. 

So  far  as  your  influence  can  prevent,  do  not  allow  ill-judg- 
ing and  partial  friends  or  patients  to  go  about  overpraising  you, 
and  speaking  of  you  as  a  pet,  etc.  Inordinate  praise,  no  mat- 
ter from  whom,  is  apt  to  arouse  a  corresponding  dislike  on  the 
part  of  those  who  deem  the  praise  either  extravagant  or  mis- 
placed; and  such  injudicious  praise,  while  meaning  well,  will 
almost  surely  react  against  you,  and  do  mischief  It  might 
even  arouse  the  angriest  jealouvsy  or  hatred  on  the  part  of  bus- 


120  THE   PHYSICIAN    HIMSELF: 

bands,  aunts,  lovers,  or  others.  Perfectly  pure  physicians  have 
actually  had  to  cease  attending  in  families  where  such  jealousy 
existed,  to  prevent  causing  domestic  strife  and  estrangement. 

It  is  also  in  very  bad  taste,  and  even  injurious,  for  a  wife 
or  other  near  relative  of  a  physician  to  praise  him  inordinately, 
and  boast  of  his  great  skill  and  wonderful  cases  and  cures ;  for 
people  very  naturally  think  such  boasting  is  an  attempt  to  send 
fish  to  his  hook  and  grist  to  his  mill.  If  done  at  all,  it  comes 
with  more  grace  from  comparative  strangers. 

Probably  one  of  the  most  constantly  useful  faculties  you 
could  possess  is  the  power  of  discovering,  by  a  study  of  faces, 
etc.,  which  are  the  ruling  spirits  in  a  family,  and  honestly  se- 
curing their  good-will,  and  keeping  them  satisfied  with  your  ser- 
vices and  your  remedies.  Also,  learning  the  character  and  con- 
sequence of  those  who  are  likely  to  show  dissatisfaction  and 
give  you  trouble  if  opportunity  offers. 

While  making  your  visits  it  is  better,  as  a  rule,  to  give 
your  attention  chiefly  to  the  reports  and  conversation  of  the 
husband,  if  he  be  present,  rather  than  to  the  wife,  and  to  ad- 
dress your  opinions,  explanations,  and  remarks  to  him,  or,  in 
his  absence,  to  whoever  is  at  the  head  of  those  w-hom  you  meet 
in  the  sick-room,  and  to  pay  to  all  others  only  the  respect  that 
civility  requires.  If  you  do  not  do  this  sensitive  "  head  ones  " 
will  feel  ignored,  and  many  will  even  get  dissatisfied  and  create 
trouble  for  you. 

Carefully  avoid  making  communications  to  inquisitive  or 
hostile  nurses,  or  other  prying  mischief-makers,  and,  if  necessary 
to  answer  their  questions,  do  so  in  an  ordinary  voice,  and  not  in 
seemingly  confidential  whispers. 

Wlien  making  a  professional  visit,  banish  all  else  from  your 
mind  but  the  case  before  you;  and,  no  matter  who  may  be  present, 
let  the  patient,  whether  young  or  old,  be  the  central  object,  and 
keep  your  thoughts  and  your  conversation  centred  on  him  and 
his  case.  Both  patients  and  their  friends  will  naturally  feel  more 
anxious  to  know  what  vou   tliink  of  their  cases,  and  to  receive 


HIS    REPUTATION    AND    SUCCESS.  121 

suggestions  and  advice  for  their  benefit,  than  to  hear  anything 
else.  If  the  conversation  digress  to  other  subjects,  change  it 
back  to  your  patient  and  his  case  as  soon  as  possible. 

Adopt  the  same  precautions,  also,  during  consultations,  and 
keep  the  conversation  between  you  and  your  colleague  on  the 
case  under  consideration,  and  do  not  allow  it  to  digress  to  re- 
ligion, horses,  politics,  etc. ;  economy  of  time,  both  on  your  own 
and  your  patient's  account,  requires  it,  for,  if  a  consultation  lasts 
too  long,  it  is  apt  either  to  terrify  the  patient  and  his  friends,  or 
induce  a  belief  that  you  disagree,  or  are  puzzled,  or  are  talking 
horses  or  politics,  either  of  which  may  undo  you. 

Skilli'ulness  in  changing  or  modifying  your  diagnosis  or 
prognosis  is  all-important  in  all  cases  where  a  change  has  to  be 
made. 

In  prognosticating  the  probable  duration  of  a  case,  do  not 
too  hastily  or  definitely  commit  yourself;  for  whatever  prognosis 
you  foreshadow  at  the  outset  will,  as  a  rule,  be  accepted.  It 
is  only  when  such  prognosis  is  altered  and  assumes  a  graver 
form,  or  the  duration  which  you  have  assigned  for  the  case  is 
much  lengthened,  that  dissatisfaction  arises.  One  of  the  great- 
est of  all  reproaches  to  medicine  is  that  it  is  not  an  exact  science; 
consequently,  the  practice  of  it  must  lack  the  element  of  certainty. 

Do  not  get  insulted  at  the  foibles  and  infirmities  and  the 
hasty  and  angry  words  of  your  patients.  Do  not  forget  that  the 
sick,  unless  tlieir  sensibilities  are  blunted  by  disease,  are  the  most 
sensitive  and  the  most  selfish  of  mankind;  and  bear  with  the  rude 
and  discourteous  treatment  you  will  occasionally  receive  from  the 
hysterical  and  the  peevish,  whose  patience  is  down  to  zero  and 
petulance  up  to  a  hundred;  and  from  the  frenzied,  the  eccentric, 
the  unreasonable,  the  impulsive,  the  irritable,  the  weak,  the  excit- 
able, and  the  low-spirited  ;  and  do  not  take  anything  a  sick  or 
silly  person  says  in  a  paroxysm  of  anger,  or  during  a  period  of 
despondency,  or  in  great  pain  (or  for  want  of  sense)  as  a  personal 
insult,  unless  you  believe  it  is  deliberately  and  willfully  intended 
as  such;  in  that  case,  do  whatever  self-respect  seems  to  dictate. 


122  THE   PHYSICIAN    HIMSELF: 

Beware  of  confidants,  and  never  become  so  partial  to  pa- 
tients, or  others,  as  to  make  them  the  repository  of  your  profes- 
sional or  personal  secrets.  Witli  our  imperfect  therapeutical 
means  we  cannot  always  attain  perfect  results  or  give  com[)lete 
satisfaction,  and  some  of  those  whom  you  have  served  most 
fait]  1  fully,  and  regard  as  unlikely  ever  to  change,  will  surprise 
and  shock  you  by  turning  round  and  loudly  decrying  you.  Bear 
the  possibility  of  this  ever  in  mind,  and,  while  seeking  to  make 
your  relations  with  your  friends  and  patients  cordial,  frank,  and 
free,  take  care  to  avoid  telling  secrets  and  making  confessions 
that  might  be  spitefully  revealed,  or  put  you  in  their  power,  if 
a  rupture  of  friendship  should  ever  occur. 

When  urgent  necessity  or  great  danger  requires,  you  need 
not  hesitate  to  do  the  most  menial  work  for  a  suffering  patient ; 
but,  unless  these  exist,  pulling  off  your  coat  or  collar,  adminis- 
tering injections,  giving  baths,  swaddling  newborn  babes,  nurs- 
ing the  sick,  dressing  or  undressing  invalids,  or  moving  about 
the  room,  rummaging  drawers  or  ransacking  cupboards  in  search 
of  towels,  muslin  for  bandages,  spoons,  goblets,  etc.,  in  the  pres- 
ence of  other  help,  as  a  servant  would,  does  not  comport  with 
professional  dignity,  and  may  be  quoted  as  evidence  that  you  are 
too  familiar  and  lack  proper  self-respect.  It  is  much  better  to 
ask  for  things  you  need  and  to  let  them  be  brought  to  you. 

To  be  overassiduous  in  paying  visits  when  no  sufficient 
cause  is  apparent,  or  to  be  too  deferential  and  superserviceable 
to  those  who  think  themselves  extra  good  patients,  is  very  inju- 
dicious, for  as  soon  as  one  conceives  himself  to  be  your  best 
patron,  or  that  you  are  cultivating  his  good  opinion  too  earn- 
estly, or  are  calling  oftener  than  he  needs,  he  is  almost  sure  to 
undervalue  you  and  is  apt  to  quit  you. 

A  patient  who  is  improving  will  generally  be  satisfied  with 
a  much  shorter  visit,  a  slighter  examination,  and  less  perfect 
attention  in  general  than  one  who  is  not  doing  well,  and  es- 
pecially if  he  is  doing  so  well  that,  on  taking  your  leave,  you 
can  express  your  emphatic  satisfaction  with  his  progress. 


HIS   REPUTATION    AND    SUCCESS.  123 

When  a  case  is  obscure,  or  in  its  initial  stage,  be  cautious 
in  expressing  any  positive  or  unguarded  opinion ;  but  in  cases 
where  you  can  safely  do  so,  give  free,  honest  expression  to  your 
diagnosis  and  prognosis.  The  habit  of  stating  your  views 
thoughtfully  and  candidly  will  compel  you  to  search  for  the 
underlying  cause  and  to  analyze  and  weigh  details  closely ;  will 
also  discipline  your  judgment  and  force  you  to  study  your  cases, 
and  to  make  a  definite,  clear,  and  discriminating  diagnosis  in 
any  case  coming  before  you,  instead  of  rushing  in  and  examin- 
ing mthout  thermometer,  stethoscope,  or  other  aids,  lumping 
everything  under  the  term  "  biliousness  "  (i)  or  "  heavy  cold," 
"heart  trouble,"  "effects  of  malaria,"  "a  complication  of  dis- 
eases," or  some  other  ambiguous  name,  and  prescribing,  on  the 
blunderbus  principle, — that 

"Mixed  diseases  must  have  mixed  remedies," — 

afler  a  moment's  stare  at  the  face,  glance  at  the  tongue,  and 
touch  of  the  wrist,  and  an  equally  hasty  catechising  of  the 
patient  concerning  his  most  prominent  symptoms,  scarcely  stop- 
ping to  notice  or  study  the  minor  ones,  or  waiting  for  a  reply  or 
maturing  an  opinion,  and  being  off  again  in  a  moment, — as  is 
too  often  done  by  careless  routinists. 

A  careless  or  superficial  examination  of  patients,  or  in- 
attention to  the  history  of  tedious  cases,  neglecting  to  give  a 
definite  name  to  a  disease,  or  calling  it  by  a  wrong  one,  or 
making  light  of  it  at  the  outset,  has  caused  regret  and  loss  of 
practice  to  many  a  physician. 

It  may  be  important  for  you  to  remember  that,  contrary  to 
the  popular  belief,  the  art  of  medicine  does  not  enable  you,  or 
any  one  else,  to  diagnose  positively  any  of  the  eruptive  fevers 
until  their  local  manifestations  appear.  Where  obscurity  exists 
state  it,  for  if  you  give  a  positive  opinion  and  it  turns  out  to  be 
incorrect  your  reputation  will  suffer. 

Frequently,  when  a  case  is  grave,  and  you  are  being  im- 
portuned to  know  whether  you  cannot  do  more,  it  is  expedient 
casually  to  mention   the  things  you  deem  contra-indicated, — 


124  THE    PHYSICIAN    HIMSELF: 

leeching,  cupping,  mustard,  rubbing,  baths,  poultices,  mopping 
the  throat,  electricity,  etc., — and  tell  why  you  have  not  had 
recourse  to  them,  so  that  they  may  realize  the  fact  that  you  are 
wide  awake  and  liave  thought  of  them,  but  have  good  reasons 
for  not  using  them. 

Never  pronounce  any  one's  sickness  feigned  or  trifling 
unless  absolutely  positive  that  it  is  so,  and,  moreover,  never 
make  fun  of  people  sending  for  you,  or  being  alarmed  at  what 
may  to  you  appear  trifling  ailments  or  simple  growths  that 
will  get  well  of  themselves  or  that  require  no  treatment,  etc. ; 
indeed,  you  should  never  joke,  talk  frivolously,  or  laugh  about 
your  patients  or  their  sicknesses,  either  in  their  presence  or 
elsewhere,  nor  taunt  them  about  the  trifling  nature  of  their 
diseases.  Some  people  will  laugh  off  your  treating  their  slight 
ailments  slightingly,  while  secretly  they  ^vill  feel  deeply  hurt 
and  resolve  never  to  have  you  again,  but  see  another  physician, 
or  perhaps  resort  to  quack  medicines  for  fear  he  might  also 
laugh.  Still  another  reason  is  that  trifling  ailments  sometimes 
develop  into  serious  diseases,  and  simple  tumors  may  assume  a 
malignant  form,  and  their  becoming  so  through  fatal  loss  of  time 
in  recognizing  the  true  nature  of  the  disease  is  very  apt  to  be 
ever  after  blamed  on  the  jesting  physician. 

Again,  never  guarantee  a  cure,  or  certain  success,  or  a  sure 
recovery,  for  anything, — even  a  mosquito-bite  ;  guarantee  noth- 
ing, except  that  you  know  your  duty  and  will  do  it ;  that  if 
your  patients  will  do  their  best  you  will  do  your  best,  and  leave 
the  result  to  God.  Medicine  is  not  a  perfect  science,  nor  is  life 
a  definite  quantity.  When  pressed  by  persons  who  want  the 
consolation  of  certainty  to  say  that  this,  that,  or  the  other  case 
of  sickness  is  not  dangerous,  it  may  in  some  instances  be  well 
to  reply  promptly,  "  Of  course,  no  one  can  say  there  is  no  dan- 
ger, because  there  is  danger  in  everything,  and  any  sickness, 
even  a  fly-bite  or  a  pin-scratch,  may  prove  fatal;"  tliat  thousands 
of  lives  have  been  lost  when  the  danger  did  not  seem  greater, 
and  tens  of   thousands   have  been  rescued  from  danger  that 


HIS    REPUTATION    AND    SUCCESS.  125 

seemed  more  imminent,  and  that  even  a  well  person  has  no 
guarantee  of  life  from  one  day  to  another.  Also,  remind  the 
questioner  that  you,  the  physician,  are  hut  a  mortal  man,  and 
that  you  do  not  possess  supernatural  wisdom,  and  do  not  hold 
in  your  hands  the  keys  of  life  and  death,  and  have  not  life- 
giving  power;  that  your  will  and  God's  will  may  differ;  and 
that,  since  medicine  is  not  a  life-insuring  science,  you  cannot 
guarantee  that  any  case  of  sickness  may  not  develop  some  new 
symptom  and  become  dangerous  or  have  an  unfavorable  issue, 
or  even  end  in  death ;  then  state  what  you  think  will  be  the 
probable  issue  of  the  case  in  question,  llemember,  too,  that 
while  every  case  presents  a  group  of  probabilities  it  is  sur- 
rounded by  a  chain  of  possibilities, — a  fact  that  you  should  not 
fail  to  mention, — and  thus  leave  yourself  a  reasonable  margin 
for  uncertainties. 

In  giving  death-certificates  in  mania-a-potu,  syphilis,  abor- 
tion, etc.,  never  yield  to  importunities,  or  a  false  tenderness  for 
family  affliction,  and  substitute  other  pleasant-sounding  terms 
that  may  possibly  put  you  in  a  false  position. 

The  laws  everywhere  confer  on  physicians  honors,  immu- 
nities, and  judicial  powers  that  are  withheld  from  other  classes. 
You  are  exempted  from  military  and  jury  duty,  and  made  an 
officer  of  the  law  over  other  citizens  regarding  insanity,  vaccina- 
tion, etc.,  and  your  certificates  with  reference  to  births,  deaths, 
inability  to  attend  court,  serve  on  juries,  do  military  duty,  etc., 
are  everywhere  respected,  and  it  is  most  certainly  your  civil  and 
moral  duty  as  a  good  citizen  to  comply  cheerfully  and  promptly 
with  all  necessary  restrictions  and  legal  requirements, — to  aid, 
rather  than  impede,  enforcement  of  the  laws. 

Further,  in  giving  certificates,  it  is  best  to  certify,  "  In  my 
opinion,"  etc.  Indeed,  not  only  is  it  more  prudent,  but  far  less 
pretentious,  in  expressing  an  opinion,  written  or  oral,  always  to 
state  simply,  "  I  believe  thus  and  so,"  or  "  In  my  opinion,"  etc. 
The  fact  that  it  is  your  opinion  or  belief  no  one  can  dispute, 
even  though  it  should  prove  erroneous. 


126  THE    PHYSICIAN    HIMSELF  I 

Be  exceedingly  cautious  in  giving-  certificates  of  insanity, 
with  a  view  to  consign  patients  to  an  insane  asylum,  and  never 
yield  to  the  importunity  of  mistaken  or  designing  persons,  and 
be  guilty  of  the  cruelty  of  depriving  a  fellow-creature  of  his 
rights,  liberty,  and  i)roperty  because  he  has  temporary  insanity, 
is  harmlessly  eccentric,  or  entertains  some  harmless  crotchet,  as, 
for  instance,  tliat  he  is  a  grandee,  or  that  his  legs  are  of  glass,  or 
that  some  lady  of  high  rank  is  in  love  with  him,  while  in  all 
other  respects  he  is  sane  and  demeans  himself  and  manages  his 
property  rationally.  Be  careful  to  distinguish  between  the 
really  insane  as  contemplated  by  law,  and  those  who  are  only 
seemingly  so.  Dissatisfied  friends  of  such  people  sometimes 
give  great  trouble  to  accommodating  physicians  in  these  cases. 
Refuse  to  give  certificates  in  all  but  clear  cases,  and  keep  a 
memorandiun  of  all  the  facts  in  each. 

Keep  memoranda  also,  and  be  very  guarded  when  called 
as  a  witness  in  will  cases,  suits  for  divorce,  etc.,  with  a  view  to 
protect  yourself  and,  maybe,  others  against  traitorous  friends  or 
designing  enemies. 

Rancorous  feuds  and  venomous  contests  among  those  in- 
terested in  wills  and  estates  will  occasionally  arise  and  show 
you  how  selfish,  and  bitter,  and  mean,  and  unscrupulous  man- 
kind can  be  over  dead  people's  old  clothes  and  the  dirty  dollar. 
In  all  such  disputes  and  family  wars  carefully  avoid  entangle- 
ment. 

"Gold  begets  in  brethren  hate, 
And  gold  doth  friendships  separate." 

Never  conceal  the  presence  of  a  contagious  disease  from 
those  around  who  are  liable  to  contract  it,  or  misrepresent 
small-pox  as  "  measles,"  or  cholera  as  "  intestinal  catarrl),"  or 
yellow  fever  as  "the  bilious,"  etc.,  as  lias  been  done,  or  you 
may  very  justly  encounter  the  condemnation  of  the  community 
at  large.  When  your  decisions  concerning  the  presence  of,  or 
danger  from,  cases  of  infections  diseases  (small-pox,  scarlatina, 
typhus  fever,  etc.),  and  of  their  origin  here,  there,  or  in  the  other 


HIS    REPUTATION    AND    SUCCESS.  127 

place,  from  local  or  domestic  causes,  militate  against  the  wishes 
or  su})posed  interests  of  liotel-keepers,  store-keepers,  boarding- 
lionse  mistresses,  etc.,  your  views  will,  in  all  probability,  be  met 
by  strong  opposition.  In  such  event,  do  not  allow  yourself  to  be 
brow-beaten  into  allowing  any  one  to  violate  the  laws  relating 
to  the  public  health.  Your  duty  to  the  healthy  is  quite  as  great 
as  to  the  diseased.  Indeed,  the  protection  of  the  public  health 
is  of  far  greater  importance  than  the  well-being  of  any  indi- 
vidual. AVhen,  therefore,  these  or  other  dilemmas  present 
themselves,  adopt  Davy  Crockett's  wise  motto : — 

"  Be  sure  you  are  right,  then  go  ahead.' 

Be  careful  to  prevent  children,  in  whose  family  contagious 
disease  exists,  from  infecting  others  by  attending  school,  or  other- 
wise mingling  with  those  liable  to  contract  it  from  them,  and 
at  the  same  time  insist  upon  visitors  being,  excluded.  Take 
care,  also,  that  its  presence  in  hotels,  stores,  etc.,  is  not  kept 
secret  at  the  public  risk. 

Never  let  people  know  that  you  are  just  from  a  case  of 
small-pox,  scarlet  fever,  measles,  etc.,  or  even  that  you  are  at- 
tending any  contagious  disease,  for,  in  the  event  of  any  case  oc- 
curring among  those  to  whom  you  have  made  it  known,  blame 
will  certainly  be  attached  to  you  as  having  been  the  cause.  If 
your  practice  is  so  full  of  such  cases  that  you  must  tell  it  to 
somebody,  tell  the  health  authorities;  indeed,  the  public  good 
requires  that  you  inform  them  anyhow. 

After  visiting  contagious  diseases,  take  care  to  disinfect 
your  clothes  by  walking  or  riding  in  the  open  air;  also,  wash 
your  hands  with  very  hot  water,  or,  if  that  be  not  at  hand,  hold 
them  over  the  fire;  disinfecting  lotions,  etc.,  may  likewise  be 
used  with  advantage;  and  further,  if  necessary,  take  a  warm 
bath,  or  even  a  Turkish  bath. 

Oppose  the  conveyance  of  diphtheria,  scarlet  fever,  measles, 
small-pox,  cholera,  yellow  fever,  typhus  fever,  and  other  con- 
tagious diseases  in  hacks,  cars,  and  other  public  vehicles,  and,  if 


128  THE   PHYSICIAN    HIMSELF: 

private  ones  are  used,  give  specific  instructions  for  their  subse- 
quent disinfection.  Protest,  also,  against  the  attendance  of 
friends  at  the  funerals  of  persons  who  have  died  of  such  diseases, 
and  insist  on  the  imperative  moral  obligation  that  infecting 
particles  from  the  dead  must  not  be  allowed  to  imperil  the 
living.  Make  it  your  duty  to  enlighten  the  public  on  this 
melancholy  subject ! 

Never  keep  a  tongue-depressor  for  indiscriminate  use,  for, 
irrespective  of  the  disgust  that  patients  would  naturally  feel  at 
having  an  instrument  put  into  their  mouths  that  had  served  a 
like  purpose  in  many  others,  it  might  actually  convey  tlie  virus 
of  syphilis,  diphtheria,  etc.,  from  one  patient  to  another,  and 
render  you  liable  to  very  grave  censure.  When  you  wish  to 
examine  a  throat  at  the  patient's  home,  it  is  better  to  ask  the 
nurse  for  a  clean  spoon,  than  to  take  a  tongue-depressor  from 
your  pocket,  or  spatula  from  your  case,  and  excite  the  patient's 
aversion  and  a  lively  curiosity  among  those  present  to  know 
upon  what  kind  of  a  case  it  was  last  used.  At  your  office  a 
clean,  white,  ivory  paper-folder,  kept  lying  on  your  desk,  not 
only  serves  its  usual  purpose,  but  also  answers  very  well  for 
ordinary  examinations ;  it  is  not  at  all  disgusting,  and  is  easily 
cleaned. 

It  is  both  right  and  proper  that  you  should  cheerfully  lend 
a  helping  hand  to  aid  a  professional  friend  or  great  scientific 
superior,  when  he  has  any  kind  of  case  requiring  it,  and 
unite  your  friendly  assistance  with  any  member  of  the  profes- 
sion where  humanity  requires,  or  in  any  case  that  will  either 
give  you  knowledge  that  you  specially  desire,  or  increase  your 
reputation  in  a  specialty  in  which  you  are  interested;  but  be 
careful  how  you  lend  yourself  as  a  jump-jack  to  bungling  prac- 
titioners who  would  use  you  as  a  handicraftsman  for  their  own 
benefit  and  repute,  or  run  about  assuming  half  (or  all)  of  the 
responsibility  in  cases  of  fracture,  wounds,  luxations,  etc.,  for 
third — or  fourth — rate  Sir  Astley  Coopers,  or  administer  the 
chloroform,  hold  instruments,  thread  needles,  use  sponges,  etc., 


HIS    REPUTATION    AND    SUCCESS.  129 

for  Dr.  Rainbowe  or  Dr.  Blockhead  in  their  ambidextrous  hack- 
ing and  hewing,  cutting  and  slashing  exploits, — 

"In  every  act  such  mind  the  motto  old  : 
'Be  bold  !  Be  bold  !  and  everywhere.  Be  bold  ! '  " — 

unless  you  are  properly  compensated  for  the  work  you  do  and 
for  the  responsibility  entailed. 

Obsequiousness  and  subserviency  should  be  heedfully 
avoided,  for,  not  only  will  they  never  be  of  any  solid  benefit  to 
your  reputation,  either  in  the  eyes  of  the  public  or  of  the  profes- 
sion, but  bad  results  in  cases  to  which  you  are  carried  to  assist 
the  hero  tend  to  depreciate  you  and  to  do  you  harm.  It  is 
much  better  for  you,  as  an  aspirant,  to  come  out  and  stand  be- 
fore the  world  on  your  own  foundation. 

For  somewhat  similar  reasons,  if  sickness,  accident,  or  other 
providential  contingency  compel  a  neighboring  physician  to 
ask  you  to  attend  his  patients  for  a  short  while,  whatever  you 
earn  should  be  tendered  to  him ;  but  if  one  incline  to  neglect 
his  business  for  dissipation,  or  to  pursue  pleasure,  he  cannot 
expect  you  gratuitously  to  attend  for  him  either  long  or  often. 

Preaching  morals  to  dissolute  patients  seldom  effects  any 
practical  good  or  makes  the  vicious  virtuous,  as  moral  distem- 
pers are  usually  too  deeply  rooted  to  be  overcome  by  an  appeal 
to  the  feelings;  but  you  often  can,  by  earnest,  truthful  advice 
and  proper  cautions,  reconcile  the  estranged  and  calm  the  angry, 
and  possibly  turn  the  drunkard  from  his  path.  You  can  also 
exert  the  greatest  influence  upon  patients  who  are  being  injured 
by  indulging  to  excess  in  chewing,  smoking,  tippling,  feasting, 
dancing,  late  hours,  carousing,  venery,  the  use  of  cosmetics,  and 
other  things  that  provoke  or  render  them  liable  to  disease. 
Your  injunctions,  indeed,  in  regard  to  these  weaknesses,  follies, 
and  errors,  if  properly  given,  will  be  respectfully  and  attentively 
listened  to,  and  will  frequently  be  strictly  obeyed. 

When  tipplers  tell  you  that  they  intend  to  "  swear  off " 
for  a  definite  period,  advise  them,  instead  of  swearing  off,  to 
pledge  their  word  neither  to  treat  any  one  nor  allow  any  one  to 


130  THE   PHYSICIAN    HIMSELF: 

treat  them   to   liquor  during    the  prescribed  period.     Such  a 
pledge  will  be  more  manly  and  more  apt  to  be  observed. 

"  Eggs  and  oaths  are  easily  broken." 

Treating  and  the  treater  make  seven  drunkards  in  every  ten. 

The  various  quack  bitters  advertised  and  guaranteed  to  be 
"  a  wonderful  discovery  "  are  almost  invariably  some  vile  com- 
pound of  bad  rum  or  bad  whisky,  and  are  the  origin  of  much 
drunkenness ;  you  should  point  out  the  dangers  and  condemn 
their  use.  If  a  person  icill  take  alcoholic  stimulants,  advise 
him  to  take  them  "  bare-footed  " ;  then  he  will  know  what  kind 
and  how  much  he  is  taking. 

A  word  about  photographs  may  fitly  close  the  chapter.  If 
you  adopt  the  habit  of  presenting  your  photograph  to  every  one 
enamored  of  your  professional  skill,  or  of  your  manners,  good 
looks,  style  of  dress,  etc.,  it  will  be  the  cause  of  many  awkward 
dilemmas.  Many  patients  who  would  swear  by  you  one  week 
will  curse  about  you  the  next,  perhaps  charge  that  you  have  mal- 
treated them,  killed  their  children,  crippled  their  wives,  or  done 
something  else  equally  horrible.  You  will  learn  by  melancholy 
experience  that  the  minds  of  men  (and  of  women  too)  are  sub- 
ject to  rapid  changes.  Many  who  would  regard  your  picture 
with  highest  esteem  this  month  or  this  year  would  tear  it  down 
or  give  it  to  the  hangman  the  next.  Trifles  light  as  air  will 
sometimes  serve  to  detach  families  from  you ;  a  whim,  a  word, 
a  look,  or  a  nod  will  sometimes  break  links  that  have  been  form- 
ing for  years ;  indeed,  even  old  patients  whom  you  have  served 
through  cold  and  heat,  darkness  and  light,  rain  and  sunshine, 
will  drop  or  dismiss  you  when  they  get  ready,  with  less  ceremony 
and  less  regret  than  you  would  an  office-boy  or  an  hostler. 


I 


CHAPTER  V. 

"  A.  inind  fraught  with  integrity  is  the  most  august  possessiou." 

Have  due  and  proper  respect  for  religion.  Your  profession 
will  frequently  bring-  you  into  contact  with  the  clergymen  of 
various  denominations.  Do  right,  and  you  will  not  only  find 
in  them  firm  friends,  but  also  your  chief  supporters  in  many  of 
your  most  trying  cases.  The  ministrations  of  a  cheerful,  dis- 
creet, and  pious  clergyman, — the  Messenger  and  Servant  of  the 
Most  High  God,— 

"With  a  face  like  a  benediction," — 

who  confines  himself  to  his  true  vocation,  i.e.,  healing  the  mal- 
adies of  the  soul,  applying  salutary  balms  to  the  wounded 
conscience,  binding  up  the  broken-hearted,  and  comforting  those 
who  mourn,  with  remedies  prescribed  by  the  Great  Physician, 
are  sometimes  more  useful  to  a  worn-out  and  irritated  patient 
than  medicine ;  and  even  in  cases  in  which  death  is  near  and 
inevitable,  calm  resignation  often  takes  the  place  of  despondent 
fear  and  apprehension  when  the  invalid  is  skillfully  informed 
of  the  probability  of  death.  In  fact,  when  cheered  and  sus- 
tained by  religion,  and  impressed  with  the  belief  that  whatever 
may  occur  they  are  in  God's  hands,  many  of  the  careworn  and 
sick  show  as  little  regret,  upon  being  gently  apprised  of  the 
probable  near  approach  of  death,  as  a  traveler  doeswhen  about 
to  start  on  a  pleasant  journey. 

"  And  hope,  like  the  rainbow  of  summer, 
Gives  a  promise  of  Lethe  at  last." 

When  summoned  to  attend  cases  of  angina  pectoris,  aneu- 
rism, organic  heart  disease,  desperate  wounds,  paralysis,  or  other 
serious  injuries  and  diseases  that  create  liability  to  sudden  death, 
])rudence  may  require  you  to  conceal  from  the  patient  the  dan- 
ger of  death,  lest  he  at  once  lose  all  hope  and  be  overcome  by 
despair  and  tumultuous  grief,  which  may  exercise  a  grave  and 

(131) 


132  THE   PHYSICIAN    HIMSELF: 

possibly  fatal  influence  ;  these  may  even  render  mild  diseases 
fatal  in  persons  of  a  nervous  constitution.  In  such  cases,  how- 
ever, take  care  to  give  timely  private  warning  to  those  especially 
interested,  and  never  deceive  them  willfully,  and  never,  so  far 
as  it  is  possible  to  avoid  it,  let  any  fellow-creature — high  or  low, 
rich  or  poor — pass  away  from  life  without  your  making  the  prob- 
ability of  such  an  event  known  to  relatives,  friends,  or  neighbors. 
Be  also  exceedingly  careful  in  talking  before  children  laid  up 
with  scarlatina,  variola,  rubeola,  etc.,  of  the  danger  of  compli- 
cations, or  of  their  illness  being  serious  or  dangerous,  and  never 
terrify  them,  when  they  are  to  be  operated  upon,  by  loud  prep- 
arations and  an  awful  array  of  instruments;  also,  take  care  to 
banish  from  their  minds  the  fear  of  hydrophobia,  lock-jaw,  etc., 
for  many  young  children  fully  realize  the  meaning  of  death,  and 
giving  their  cases  such  frightful  importance  would  tend  to  ter- 
rify them.  Be  alike  cautious  in  speaking  within  hearing  of 
patients  who  seem  to  be  sleeping,  drunk,  semi-comatose,  etc. 
Bear  in  mind  that  a  person,  young  or  old,  is  not  always  asleep 
when  his  eyes  are  shut. 

In  this  world  of  short  meetings  and  long  farewells  it  is  just 
as  natural  to  die  as  to  be  born,  and  every  one's  time  must  come 
sooner  or  later,  and,  although  you  can  neither  see  what  is  writ- 
ten in  the  Book  of  Life  nor  detain  the  living  soul  when  sum- 
moned by  the  Angel  of  Death,  you  will  sometimes  have  cases 
in  which  you  will  seem  to  be  vainly  fighting  death  itself,  and 
yet,  to  your  astonishment,  see  the  patient  recover  as  if  by  resur- 
rection ;  and,  on  the  other  hand,  you  will  often  discover  that 
the  patient  has  almost  entered  the  gates  of  death,  while  friends 
around  think  that  he  is  getting  better,  until  your  practical  skill 
enables  you  to  detect  the  gloomy  fact.  Be  prepared,  therefore, 
for  such  incidents. 

In  serious  illness  you  can  very  properly  prepare  the  way  for 
the  introduction  of  the  clergyman,  but  you  should  never  attempt 
to  thrust  your  religious  beliefs  or  disbeliefs  or  your  political  opin- 
ions upon  patients  who  hold  opposite  views.    Your  specific  duty 


HIS    REPUTATIOif   AND    SUCCESS.  133 

is  with  the  patient's  body,  and  it  is  really  no  part  of  your  duty 
to  proselyte  or  to  administer  to  the  religious  cravings  of  the  sick. 
Every  sect  has  a  clergy  of  its  own,  to  teach  religion,  to  soothe 
the  parting  moments  of  the  dying,  and  to  make  the  sad  event  a 
useful  lesson  to  the  survivors,  and  to  these  you  must  leave  the 
spiritual  work.  We  are  the  physicians  of  the  physical  body, 
the  temporal  life ;  they  are  the  physicians  of  the  eternal  life,  of 
the  soul.  Do  little  or  no  theological  talking  or  teaching,  and, 
for  the  sake  of  spiritual  decency,  advance  nothing  that  you  do 
not  believe  and  feel,  that  your  lips  may  remain  unaffected  and 
your  hands  unspotted.  Veil  your  views  and  confine  your  min- 
istrations to  the  worldly  welfare  of  patients,  and  never  obtrude 
anything  in  religious  matters  that  involves  a  creed  antagonistic 
to  that  of  the  sufferer,  and  never  belittle  anything  theological 
that  the  sick  earnestly  and  honestly  believe. 

The  momentous  question  of  eternity  is  certainly  more  im- 
portant than  the  transitory  things  that  belong  to  earth ;  be, 
therefore,  ever  ready  not  only  to  allow,  but,  if  need  be,  to  ad- 
vise patients  to  have  spiritual  comfort. 

Religion  does  good  not  only  hereafter,  but  here ;  indeed, 
the  presence  of  religious  faith  pointing  to  a  life  of  blessedness 
and  immortality  is  a  power  that  can  assuage  the  keenest  sorrow 
and  suffering,  and  even  make  the  avenues  to  death  smooth; 
and  if  any  physician  doefe  not  recognize  it,  or  if  he  feels  con- 
tempt for  religious  practices  or  feelings,  or  speaks  slightingly  of 
religious  beliefs,  he  {need  I  add?)  lacks  the  A  B  C  of  philos- 
ophy and  observation.  Your  own  eyes  will  see  many  a  poor, 
sick,  woe-worn,  despondent,  and  broken-hearted  creature  calmed 
in  mind  and  soothed  in  body  by  its  comforting  and  cheering  in- 
fluence, and  aided  by  it  to  get  well,  if  his  ailments  are  at  all 
curable ;  if  not  curable,  his  spiritual  wants  being  supplied  by 
the  citation  of  the  Bible  promise  that 

"These  ruins  shall  be  built  again, 
And  all  this  dust  shall  rise," 

and  by  the  repetition  of  the  Saviour's  name,  and  the  voice  of 


134  THE   PHYSICIAN    HIMSELF: 

prayer  to  a  benign  Father,  he  gets  unfaihng  faith,  patience, 
resignation,  and  hope  from  it,  seems  thankful  to  hear  the  worst, 
and  becomes  wilHng,  or  even  anxious,  for  the  hour  of  departure. 
Indeed,  one  who  has  strong  rehgious  hopes  is  more  hkely  to 
survive  a  severe  disease  and  go  on  to  longevity  than  one  who 
has  not. 

"Hope  is  the  pillar  of  the  world." 

The  involuntary,  mechanical,  automatic  agitations,  and 
seemingly  anxious  movements  unconsciously  made  by  many  of 
the  dying  are  popularly  supposed  to  be  attempts  to  communi- 
cate some  remaining  thoughts,  or  secrets,  or  special  wish  before 
death.  In  such  cases  do  not  fail  to  explain  to  the  friends  that 
a  kind  Providence  has  mercifully  draw^n  the  veil  of  unconscious- 
ness around  the  dying,  and  that  he  is  insensible  to  suffering ; 
that  the  merchant  has  then  forgotten  his  ships,  the  miser 
his  gold,  tlie  millionaire  his  possessions,  and  the  beggar  his 
poverty. 

The  act  of  dying,  in  itself,  is  probably  painless,  and  the 
last  stages  of  painful  diseases  are,  as  a  rule,  less  so  than  those 
that  precede ;  but  the  dying  struggle,  though  painless  to  the  un- 
conscious patient,  is,  nevertheless,  often  distressingly  hurtful  and 
harrowing  to  all  who  witness  it. 

Respect  the  religious  belief  of  your  patients  ;  it  is  well  that 
you,  as  a  physician,  whether  a  Roman  Catliolic  or  not,  should 
be  famiUar  with  the  following  duties  required  at  the  hands  of  a 
physician  by  Catholic  patients  : — 

When  in  attendance  on  Catholic  families,  be  especially 
careful,  in  cases  of  dangerous  illness,  to  warn  the  immediate 
friends  of  danger,  that  the  sufferer  may  receive  the  last  sacra- 
ments. 

One  of  the  seven  sacraments  of  the  Great  Church  of  Rome 
is  Extreme  Unction.  It  is  believed  to  purify  the  soul  of  the 
dying  from  any  sin  not  previously  expiated  through  other  sacra- 
ments, and  to  give  strength  and  grace  for  the  death  struggle. 

This  church  teaches  that  moral  responsibility  begins  at  the 


HIS   REPUTATION    AND    SUCCESS.  135 

age  of  reason ;  therefore,  Extreme  Unction  is  necessary  for  all 
Avho  have  attained  that  age. 

Extreme  Unction  is  given  but  once  in  the  same  illness,  but 
if  the  patient  has  recovered  and  shortly  afterward  has  the  same, 
or  any  other  kind  of  dangerous  sickness,  this  sacrament  is  again 
necessary. 

Another  of  the  seven  sacraments  of  the  Church  of  Rome, 
with  which  you  should  be  familiar,  is  the  Holy  Eucharist. 

The  Holy  Eucharist,  sometimes  called  the  Wafer,  is  be- 
lieved to  contain  Christ's  whole  being, — his  body,  soul,  and  di- 
vinity. It  may  be  administered  frequently  in  all  cases  of  sick- 
ness in  which  the  patient  is  confined  to  the  bed  or  to  the  house 
for  any  length  of  time,  provided  he  has  sufficient  reason  to 
make  a  full  confession. 

If  the  nature  of  your  patient's  disease  is  likely  to  render 
him  unconscious,  be  careful  to  inform  the  family  of  the  fact,  so 
that  the  clergy  may  be  sent  for,  and  the  confession  be  heard, 
and  the  Holy  Eucharist  given  before  the  reasoning  powers  are 
obscured. 

Those  who  are  to  receive  the  Holy  Eucharist  are  required 
to  fast,  if  possible,  from  midnight  until  they  have  received  it ; 
but  if  you  consider  that  your  patient's  being  without  either  food 
or  medicine  would  be  detrimental  to  his  welfare  the  clergy 
should  be  informed. 

Where  there  is  excessive  nausea  and  vomiting,  the  Holy 
Eucharist  is  either  not  given  at  all  or  given  in  the  smallest 
quantity.     To  expose  it  to  being  vomited  is  a  great  irreverence. 

Be  also  equally  careful  in  Catholic  families  to  administer, 
or  have  administered,  conditional  baptism  to  all  children  during 
or  after  birth,  when  there  is  the  slightest  reason  to  doubt  their 
viability.  The  following  are  the  conditions  and  details  of  con- 
ditional baptism :  You,  or  any  one  else,  whether  a  Roman 
Catholic  or  not,  are  allowed  to  administer  it.  A  male  adult  is 
preferable  to  a  female,  and  of  course  a  Catholic,  if  one  is  at 
hand,  to  a  non-Catholic.     The  baptism  is  administered  as  fol- 


136  THE    PHYSICIAN   HIMSELF: 

lows :  After  procuring  a  glass  or  cup  of  clean  water  (spring- 
water  is  designated,  but  hydrant-,  or  pump-,  or  any  other  kind 
of  true  and  natural  water  will  do),  in  a  suitable  manner  say- 
"  I  baptize  thee  in  the  Name  of  the  Father,"  precisely  at  the 
word  "  Father  "  pouring  a  small  portion  of  the  water  upon  the 
child's  head  ;  continue,  "  And  of  the  Son,"  at  the  word  "  Son  " 
pouring  another  small  portion;  again  continue,  "And  of  the 
Holy  Ghost,"  and  at  the  words  "  Holy  Ghost "  another  small 
portion. 

Bear  in  mind  that  in  baptism  every  word  must  be  uttered ; 
were  you  to  omit  even  an  "  of"  the  baptism  would  be  insufficient. 
Also,  remember  that  the  water  must  be  true  and  natural,  and 
must  be  poured  exactly  whilst  the  formal  words  are  pronounced. 
So  very  important  are  these  details,  that  if  you  arrive  after  a 
midmfe  or  other  person  has  baptized  the  child,  carefully  ascer- 
tain whether  she  has  observed  the  full  form  and  used  accurate 
language.  If  she  has  not,  and  the  death  seems  impending,  you 
should  baptize  it  again.  In  such  a  case  of  doubt  it  is  necessary 
to  preface  the  formal  words  with,  "  If  thou  art  not  already 
baptized,  I  baptize,"  etc. 

If  in  a  midwifery  case  the  child  of  Catholic  parents  is  be- 
lieved to  be  in  danger  of  dying  it  must  be  baptized.  If  it  is 
partly  born,  baptize  on  its  head,  if  the  head  is  presenting ;  if 
not,  upon  the  hand,  or  foot,  or  any  other  part  that  is  bom.  If 
no  part  is  born,  and  you  can  reach  the  child  through  the  vagina, 
the  water  must  be  applied  to  such  part  as  can  be  touched.  In 
all  cases  of  unborn  children,  preface  the  regular  form  with  the 
words,  "  If  thou  canst  be  baptized,  I  baptize,"  etc.  In  such  a 
case  apply  the  water  to  its  body  with  a  syringe,  or  by  any  other 
means  by  which  the  water  will  remain  uncontaminated  till  it 
touches  the  child. 

In  Catholic  families  you  will  run  great  risk  if  you  use  the  for- 
ceps before  the  child  has  been  baptized ;  for  if  this  be  neglected. 
and  the  child  be  born  dead,  you  will  not  readily  be  forgiven. 

Remember  that  it  is  better  that  a  Catholic  patient  should 


HIS   REPUTATION    AND    SUCCESS.  137 

be  thrice  prepared  and  not  pass  away   than  to  go  unprepared ; 
therefore,  if  you  err  at  all,  let  it  be  on  the  safe  side. 

"A  good  judgment  is  a  great  thing." 

You  should  be  especially  careful  to  give  timely  warning  of 
danger  to  all  who  have  business  of  vital  importance  to  transact, 
and  to  those  who  have  the  best  right  to  know,  in  cases  of  sudden, 
serious  illness ;  for  instance,  friends  may  have  to  be  summoned, 
wills  executed,  and  other  arrangements  made,  and,  more  impor- 
tant still,  the  sick  may  also  wish  time  to  reflect  on  their  awful 
situation  and  the  more  serious  afl"airs  of  eternity. 

In  an  adult  with  almost  any  sickness  you  can  safely  predict 
that  a  hearse  will  be  at  his  door  in  a  few  days,  at  furthest,  after 
the  pulse  has  gradually  increased  (heart- failure)  to  160.  Also, 
if,  after  wounds  or  in  acute  sickness,  he  emaciates  to  two-fifths 
of  his  usual  weight. 

If  you  will  observe  closely,  you  will  find  that  when  a  pa- 
tient becomes  fully  and  firmly  impressed  with  the  belief  that  he 
will  die  he  is  extremely  apt  to  do  so. 

It  is  very  much  better  for  you  to  decline  to  leave  your 
sphere  as  physician  to  become  a  witness  to  wills  if  called  upon 
to  do  so,  and  especially  in  cases  in  which  you  are  not  fully  sat- 
isfied of  the  mental  capacity  of  the  testator  ;  and  determinedly 
refuse  to  take  part  in,  or  in  any  way  interfere  with,  the  settle- 
ment or  division  of  the  estate  of  those  whom  you  have  pro- 
fessionally attended,  as  you  may  thereby  incur  the  charge  of 
misusing  the  opportunities  afi"orded  you  by  your  position  as  a 
medical  attendant.  Of  course,  if  a  person  whom  you  have 
served  long,  successfully,  or  faithfully,  chooses  to  remember  you 
for  it  in  a  corner  of  his  will,  if  it  is  done  without  your  conniv- 
ance it  will  be  lucky  and  all  right. 

In  no  case  be  a  witness  to  or  executor  of  a  will  when  you 
are  made  a  legatee  or  heir,  as  any  legacy  or  pecuniary  interest 
therein  devised  to  you  will  be  void. 

When  attending  very  serious  cases,  be  careful  to  exhibit 
proper  gravity   and  sincerity,  and  never  try  to  excite  hope  in 


138  THE    PHYSICIAN    HIMSELF: 

cases  that  are  hopeless,  or  obtrude  the  cry  of  hope,  hope  !  when 
you  really  see  none.  If,  moreover,  a  very  ill,  sane  adult  really 
wishes  to  know  his  real  situation :  whether  he  is  in  great  dan- 
ger or  likely  to  die,  and  pointedly  asks  you  the  question,  answer 
him  frankly  and  truthfully  that  he  is  a  very  sick  man,  and 
state  fairly  and  fully  the  ground  on  which  your  opinion  rests, 
and  thus  relieve  yourself  of  the  responsibility ;  but,  if  possible, 
couch  your  answer  in  kind  and  gentle  language,  so  as  not  to 
appal  and  unadvisedly  depress  him  by  taking  away  all  hope 
and  substituting  despair.  At  the  same  time,  in  expressing  your 
opinion,  give  him  all  the  hope,  assurance,  and  sympathy  you 
honestly  can,  and  if  you  know  anything  favorable,  either  in  his 
physical  or  spiritual  condition,  mention  it  as  a  solace.  In  an- 
ticipation of  such  painful  incidents,  it  is  well  to  be  prepared  with 
consolatory  and  advisory  language  adapted  to  the  respective 
cases. 

You  are  at  liberty  to  be  silent  or  to  say  but  little  regarding 
the  nature  or  degree  of  a  person's  sickness,  but,  of  course,  let 
whatever  you  do  say,  whether  much  or  little,  be  conscientiously 
truthful.  You  must  not,  can  not  put  a  falsehood  in  the  place 
of  the  truth,  not  even  when  attending  to  the  sick  and  dying ; 
neither  as  a  man  nor  as  a  physician  must  you,  under  any  cir- 
cumstances, sacrifice  principle  or  honor  for  expediency,  especially 
to  a  person  in  a  terrible  and  trying  situation.  But  you  can, 
you  must,  as  far  as  possible,  soften  the  truth  and  blend  it  in  a 
proper  manner  with  feeling  and  sympathy. 

You  will  find  few  who  have  the  necessary  fortitude  and 
submissive  resignation  to  seek  to  enjoy  their  remaining  life  after 
being  told  that  their  cases  are  incurable  ;  you  should  be  cautious, 
therefore,  not  suddenly  to  cut  off  all  hope,  even  from  those 
afflicted  with  lingering  maladies, — tuberculosis,  cancer,  Bright's 
disease,  and  like  cases, — in  which  death  approaches  slowly,  like 
a  creeping  shadow,  up  to  the  last  stage,  knowing  that  persons 
with  those  diseases  have  plenty  of  time  while  sinking  away — the 
face  gradually  grows  thinner,  their  eyes  dimmer,  cheeks  paler, 


HIS    REPUTATION    AND    SUCCESS.  139 

pulse  quicker,  breatli  iaster,  limbs  weaker,  vitality  and  all  else 
lower  and  on  the  wane — gradually  to  realize  their  true  state. 
Indeed,  you  should  not,  in  such  cases,  tell  how  many  you  have 
attended  who  died  of  the  same  disease,  or  give  a  merciless 
prognosis,  containing,  like  a  death-warrant,  neither  hope  nor 
encouragement,  unless  you  are  prepared  to  be  replaced  by 
Dr.  Bigsmoke,  or  Dr.  Guller,  or  Prof.  Oilytongue,  who, 
unless  by  speaking  more  hopefully,  can  do  no  greater  good 
than  yourself.     Be  on  your  guard,  therefore. 

An  imprudent  and  ill-timed  remark  may  destroy  life 
where  buoyed-up  hope  would  preserve  it.  To  tell  a  patient  that 
he  has  a  grave-yard  cough,  or  that  he  will  never  see  spring 
again,  or  that  you  would  not  have  his  throat,  or  heart,  or  lungs, 
or  liver,  or  kidneys  for  a  thousand  dollars,  would  add  the 
depressing  influence  of  despair  to  the  sedative  influence  of  the 
disease,  and  could  not  fail  to  destroy  his  moral  will-power,  and 
either  murder  him  by  inches  or  work  serious  injury  to  his  case. 

You  may  often  prevent  despondent  and  anxious  patients — 
whose  pulse  or  temperature  has  grown  worse,  or  whose  diseased 
lungs,  heart,  etc.,  you  are  examining — from  asking  you  incon- 
venient questions  that  would  necessitate  a  disclosure  of  your 
gloomy  prognosis,  by  having  ready  on  your  tongue's  end, 
questions  regarding  their  appetite,  sleep,  state  of  the  bowels,  or 
something  else  to  ask  the  moment  you  finish  listening,  counting, 
or  testing ;  you  thus  give  them  no  period  of  solemn  silence,  and 
so,  temporarily  at  least,  no  chance  for  inopportune  questioning 
as  to  what  you  find  or  think,  or  to  see  what  your  thoughts  then 
show.     Be  prepared,  however,  for  such  at  a  later  time. 

We  have  to  do  not  only  with  sickness,  but  the  sick ;  not 
only  with  death,  but  the  dying.  It  is,  for  several  reasons,  better 
never  entirely  to  abandon  a  patient  with  consumption,  cancer, 
etc.,  even  though  he  be  incurable,  or  in  the  last  stages  of  a  fatal 
malady ;  on  the  contrary,  keep  him  on  your  list  and  visit  him, 
at  least  occasionally,  not  only  that  you  may  give  him  all  the 
comfort  you  can,  by  suggestions  for  the  relief  of  pain  and  mental 


140  THE   PHYSICIAN    HIMSELF: 

anguish,  but  that  his  sorrowing  friends — present  and  absent — 
may  have  the  very  great  consolation  of  knowing  that  their  loved 
one  will  receive  all  necessary  professional  care  and  attention  up 
to  the  very  time  the  dark  curtain  falls. 

In  every  stage  of  your  career  aim  to  convince  the  world 
that  you,  as  a  physician,  are  an  apostle  of  hope, — 

"White-handed  hope,  the  hovering  angel,  gilt  with  golden  wings," — 

of  faith,  of  sympathy,  of  comfort,  and  of  relief,  and  that  your 
profession  is  not  in  league  with  the  grim  forces  of  death  and 
mourning,  but  that,  on  the  contrary,  all  its  characteristics  are 
indicative  of  health-giving  and  life-restoring  power.  Neither 
blue-eyed  and  rosy-cheeked  Hygeia,  nor  her  parent,  ^sculapius, 
is  represented  as  in  tears,  with  the  habiliments  of  mourning ; 
but  we  see  instead  ^sculapius  armed  with  serpents,  the  symbol  of 
wisdom  and  convalescence,  and  Hygeia  is  seen  affording  to  others 
warmth  and  succor, — a  beautiful  symbol  of  health  and  preventive 
medicine. 

Remember  that  old  Mr.  Death  is  the  physician's  great 
antagonist,  and  that  when  he  defeats  your  best  efforts  and 
extinguishes  the  spark  of  life  your  duty  ends.  Do  not,  then, 
essay  (otherwise  than  mentally)  to  offer  up  a  prayer,  or  make  a 
prolonged  stay  to  administer  nervines  to  relatives  or  friends,  or 
tender  your  services  for  promiscuous  duties,  such  as  carrying 
messages,  going  for  the  barber,  or  the  undertaker,  etc.,  but  at 
the  earliest  fitting  moment  quietly  withdraw. 

Leave  the  laying  out  and  the  application  of  preservative 
fluids  to  the  face  and  body  of  the  deceased,  and  all  such 
matters,  to  the  undertaker  and  friends. 

Abstain,  also,  from  visiting  the  house  of  mourning  to  view 
the  dead  (unless  from  professional  necessity  or  obligation),  and, 
except  when  it  is  absolutely  necessary,  even  avoid  attendance 
at  the  funeral  services  of  your  deceased  patients,  or  following 
their  corpses  to  the  grave. 

More  especially  refrain  from  writing  apologetic  letters  to 


HIS   REPUTATION    AND    SUCCESS.  141 

the  bereaved,  expressing  self-reproach  for  failhig  to  recognize 
this,  that,  or  the  other  fact,  or  regret  at  not  having  followed  a 
different  course  of  treatment,  and  asking  forgiveness.  If  there 
are  any  facts  in  connection  with  the  case  that  call  for  an 
explanation,  find  occasion  to  communicate  them  verbally. 

Ours  is  a  chequered  life,  and  we  see  humanity  in  all  its  vari- 
eties,— and  are  necessarily,  familiar  with  many  of  the  most  humil- 
iating and  revolting  phases  of  human  life, — the  white  and  the 
black,  the  rich,  the  poor,  the  indigent,  the  putrid  prostitute,  the 
rascally  outlaw,  the  swaggering  rowdy  (whose  character  can  be 
read  on  his  physiognomy),  the  depraved  reprobate,  and  the 
sneaking  thug;  Swearing  Joe,  Thirsty  Jack,  Tough  Moll, 
Joking  Jim, — 

"Puns  and  sarcasm  he  would  pour  forth  at  his  own  funeral," — 

Vulgar  Sally,  and  Blackleg  Tom  (sin  in  satin  and  vice  in 
velvet),  will  all  be  represented  in  the  Babel  of  your  practice. 
Attend  anybody  if  you  must,  even  in  the  haunts  of  idleness, 
shiftlessness,  and  drunkenness,  as  your  mission  is  to  all  sick 
people, — the  vicious  as  well  as  the  virtuous  ;  but,  as  far  as  pos- 
sible, avoid  disreputable  places  and  the  incurably  wicked,  and 
do  not  be  hail-fellow-well-met  with  persons  in  whom  the  moral 
thermometer  registers  low,  as  they  are  more  Hkely  to  prove  a 
curse  than  a  blessing ;  nevertheless,  do  not  hesitate  to  do  your 
duty  to  a  suffering  fellow-creature,  however  low  in  the  scale  of 
humanity  and  morality.  At  the  same  time  remember  that  such 
Samsons  and  Delilahs  respect  no  physician  who  does  not  fully 
respect  himself,  and  take  care  to  treat  all  such  with  ceremonious 
politeness. 

Avoid  all  such  deceptive  tricks  as  to  assure  a  timid  patient 
that  you  will  not  lance  his  boil,  but  merely  wish  to  examine  it, 
and  then  suddenly  doing  what  you  assured  him  you  would  not 
attempt.  Veracity  should,  in  all  the  situations  of  life,  and 
under  all  its  circumstances,  be  your  golden  shield. 

Endeavor  to  acquire  and  maintain  a  complete  professional 
influence  over  all  your  patients,  for  unless  you  enjoy  their  con- 


142  THE    PHYSICIAN    HIMSELF  I 

fidence  and  respect  you  will  have  to  contend  not  only  against 
their  physical  condition,  but  their  mental  and  moral  also. 

You  have  a  perfect  right  to  relinquish  attendance  on  a  case 
when  you  find  your  intei'est,  or  reputation,  self-respect,  limit  of 
endurance,  or  other  valid  reason  requires  it ;  when  you  do  so, 
give  formal  notice,  and  let  the  cause  of  your  withdrawal  be 
fully  understood,  that  you  may  not  be  responsible  for  subse- 
quent occurrences.  It  is  better,  however,  to  decline  undesirable 
cases  at  the  first  interview,  on  the  plea  of  great  press  of  other 
work,  than  to  take  them,  involve  yourself,  and  then  have  to 
relinquish  or  neglect  them. 

Never  refuse  to  rise  from  your  bed  to  pay  necessary  night 
visits  to  patients ;  to  do  so  would  not  only  subject  you  to  the 
poignant  reflection  that  you  had  been  recreant  to  the  call  of 
duty,  but  would  also  be  unjust,  in  that  it  would  put  your  duty 
on  some  other  physician,  and  by  delay  cause  the  patient  un- 
necessary suftering,  possibly  death ;  or  it  might  even  drive  the 
messenger  to  a  pharmacist  for  advice  and  medicine,  or  necessi- 
tate the  calling  in  of  an  Irregular,  or  other  undesirable  person 
who  could  be  cauglit  up  in  the  emergency.  If,  however,  you 
will  make  it  a  rule  to  charge  full  night-visit  fees  for  all  visits 
made  after  bed-time,  you  will  be  spared  much  loss  of  rest  and 
night  exposure ;  calls  to  hurry  two  or  three  miles  on  cold, 
wintery  nights,  or  before  breakfast,  on  a  half-run  or  dog-trot, 
because  some  one  has  sneezed,  or  to  attend  to  other  needless 
and  harassing  demands  from  frightened  ailers,  who  fancy  they  are 
about  to  die,  and  from  others  who  could  have  sent  at  a  more 
seasonable  time.  Unnecessary/  night  visits  rob  physicians  of 
necessary  rest,  and  even  if  they  do  bring  extra  fees,  if  your  life 
is  a  busy  one,  they  afford  no  fair  equivalent  for  the  risk  to  health 
from  overwork  and  loss  of  sleep. 

Be  exceedingly  cautious  in  accepting  degraded  or  vicious 
patients,  to  be  visited  clandestinely,  and  in  having  married 
women  or  young  females  consult  you  secretly  at  your  office, — 
especially  if  it  be  for  vaginal   or  other  private  examinations, — 


HIS    REPUTATION    AND    SUCCESS.  143 

without  knowledge  of  husband  or  parents.  Also,  be  careful 
about  attending  patients  suffering  from  the  effects  of  intem- 
perance or  prostitution,  under  pretence  that  they  have  other  than 
their  real  ailment,  with  the  view  to  screen  them,  by  misleading 
their  friends  or  relatives. 

Do  not  overvisit  your  patients,  and  be  especially  careful  to 
pay  but  few  visits  to  those  with  trifling  injuries,  uncomplicated 
cases  of  measles,  mumps,  wliooping-cough,  chicken-pox,  etc. 
People  observe  and  criticise  a  physician's  course  in  all  such 
cases,  and,  if  he  apjiear  overattentive,  they  are  apt  to  believe 
either  that  tliey  are  sicker  than  he  admits,  which  will  cause 
them  great  alarm,  or  that  he  is  nursing  and  prolonging  the 
case  and  running  up  a  bill  imnecessarihj .  It  is  sometimes  an 
extremely  delicate  point  to  decide  whether  a  patient  needs 
another  regular  visit  or  not,  and  how  soon ;  whether  the  case  is 
of  a  kind  in  which  changes  are  liable  to  be  sudden  and  fre- 
quent or  not.  Practice  should  soon  enable  you  to  judge  cor- 
rectly. You  must  also  learn  the  art  of  telling  the  proper  time 
to  cease  attendance  in  different  varieties  of  cases,  so  as  to  satisfy 
the  patient  and  his  friends  that  you  are  simply  intent  on  dis- 
charging your  duty. 

Most  people  dread  the  expense  of  professional  services, 
and  excessive  attention,  numerous  visits,  and  repeated  changes 
of  treatment  are  rarely  appreciated ;  a  physician  who  pays  but 
few  visits  and  yet  cures  is  always  popular.  If  you  can  acquire 
this  habit,  and  gain  the  reputation  of  paying  no  unnecessary 
visits,  it  will  be  regarded  as  a  special  feature  in  your  favor,  and 
will  almost  double  your  practice.  A  good  and  the  only  proper 
rule  is  to  visit  your  patient  when,  and  only  when,  you  con- 
scientiously believe  it  to  be  necessary,  whether  once  a  day  or 
once  in  seven  days.  Never  go  several  times  a  day  to  observe 
the  variation  of  symptoms  or  effect  of  treatment  without  point- 
ing out  the  necessity  for  it. 

Do  not  mix  professional  and  social  visits  together;  go 
either  as  a  physician,  and  be  one,  or  as  a  friend ;  and,  above  all 


144  THE   PHYSICIAN   HIMSELF: 

else,  avoid  running  in  to  visit  patients  unnecessarily  because 
you  "  happen  to  be  in  the  neighborhood."  If  you  visit  Tight- 
fist  on  such  a  pretext,  and  charge  for  it  in  the  bill,  you  may  be 
sharply  criticised  for  making  obtrusive  visits  and  forcing  un- 
asked civilities,  and  your  bill  possibly  disputed.  On  the  other 
hand,  never  visit  a  seriously  ill  patient  so  seldom,  or  so  irregu- 
larly, as  to  lose  sight  of  the  details,  or  induce  a  belief  that  you 
are  neglectful  or  indifferent. 

Some  well-to-do  or  overanxious  people  form  an  exception 
to  this  rule,  and  insist  on  your  visiting  them  more  frequently 
than  is  necessary,  so  as  to  almost  live  at  tlieir  house  during 
sickness,  to  observe  progress,  instruct  attendants,  etc.,  regardless 
of  the  additional  expense;  and,  of  course,  you  may  gratify  them, 
provided  such  attendance  does  not  interfere  with  the  fulfillment 
of  your  duty  to  other  patients ;  but  at  the  same  time,  if  other 
than  the  patient  himself  will  have  to  pay  the  bill,  the  person 
responsible  should  (if  need  be)  be  informed  of  the  reason  why 
the  extra  visits  are  made  and  of  the  unnecessary  expense  en- 
tailed.    No  blame  can  then  attach  to  you. 

During  such  frequent  visits  you  should  maintain  a  profes- 
sional attitude,  and  avoid  the  habit  of  digressing  from  the 
patient  to  politics,  the  fashions,  or  other  current  topics ;  other- 
wise, he  and  his  friends  will  be  apt  to  lose  confidence,  after 
which  the  moral  efiect  of  your  visits  will  be  lost,  you  will  be 
shorn  of  your  influence,  and  may  receive  scant  courtesy,  and 
scarcely  be  honored  or  welcomed  at  your  visits. 

When  visiting  a  patient,  always  let  it  be  known  whether 
and  when  you  will  visit  him  again  ;  it  will  not  only  satisfy  him, 
but  prevent  all  uncertainty,  and  relieve  the  anxious  expectancy 
of  "The  Doctor's  Rap."  Remember  that  to  judge  the  condition 
or  progress  of  some  cases  it  is  better  to  visit  them  at  diflerent 
periods  of  the  day,  or  even  at  night,  while  others  should  be  seen  as 
nearly  as  possible  at  the  same  hour  each  day.  AVhen  a  case  has 
so  far  convalesced  as  to  make  frequent  visits  unnecessary,  and 
yet  improves  so  slowly  or  irregularly  as  to  make  you  fear  an  ar- 


HIS   REPUTATION   AND    SUCCESS.  145 

rest  of  improvement  or  a  relapse,  it  is  better  to  keep  an  eye  upon 
it  by  looking  in  occasionally,  and  letting  it  be  known  when  you 
will  call  again,  with  an  understanding  that  if  in  the  meanwhile 
the  patient  becomes  worse,  or,  on  the  other  hand,  if  he  gets  so 
much  better  as  to  render  your  promised  visit  unnecessary,  you 
shall  be  notified  thereof.  This  plan  is,  for  many  reasons,  better 
than  quitting  such  cases  more  or  less  abruptly. 

The  old,  chronic  cases  that  beset  our  paths  often  do  us 
great  injury ;  for  among  the  surest  fruits  of  neglecting  them 
will  be  the  employment  of  quack  medicines,  or  the  entrance  of 
an  Irregular  or  charlatan,  whom  some  busybody  has  pressed 
upon  them  during  your  absence.  It  is  very  mortifying  to  drop 
in  to  see  a  patient,  after  prolonged  neglect,  and  see  a  big  bottle 
of  quack  medicine,  or  a  vial  of  pellets,  or  the  two  tasteless 
glasses  sitting  on  the  table  beside  him,  and  then  to  hear  this  ol 
that  story  why  they  changed.  When  you  first  encounter  a  case 
already  chronic,  be  frank  and  candid  as  to  the  time  required, 
and  as  to  doubts  of  possible  cure,  and  use  no  disguise  or  equivo- 
cation, and  make  no  rash  promises. 

To  evince  an  earnestness  and  personal  interest  in  your 
cases  are  potent,  master  qualities  that  inspire  confidence  and 
respect,  and  are  often  freely  and  readily  accepted  in  place  of 
superior  skill.  Seek  therefore  to  imbue  your  mind  with  a  feel- 
ing of  genuine  interest  in  your  cases,  and  you  cannot  fail  to 
show  it  in  a  thousand  ways. 

Make  it  a  study  to  remember  well  all  that  is  said  or  done 
ut  your  visits,  so  that  your  line  of  conduct  may  be  consistent 
throughout  the  case.  Also,  take  care  neither  to  betray  a  want 
of  memory — 

"Memory  is  the  first  faculty  that  age  invades" — 

or  a  lack  of  interest,  for,  were  you  to  ask  a  patient,  "  AVhat  kind 
of  medicine  did  I  give  you  last '?"  or  to  hesitate  in  your  ques 
tions,  he  and  his  friends  would  at  once  notice  it,  and  suspecf 
that  you  either  felt  but  little  interest  in  his  case  or  suffered  from 
a  failing  memory. 


146  THE   PHYSICIAN    HIMSELF: 

Study  to  make  your  address  and  manner  such  that  patients 
will  not  hesitate  to  open  their  hearts  and  fully  impart  to  you 
their  secrets  and  the  nature,  seat,  and  cause  of  their  disease  as 
fully  as  the  pious  Catholic  would  to  his  Father  Confessor.  One 
of  the  greatest  drawbacks  to  many  physicians  is  that  they  fail 
to  inspire  complete  confidence,  and  consequently  patients  neither 
intrust  them  with  the  secrets  of  their  folly,  simpleness,  or  wicked- 
ness, nor  consult  them  in  afflictions  that  create  feelings  of  hesi- 
tancy or  shame. 

Have  little  or  nothing  to  do  with  your  patients'  family 
squabbles  or  with  their  neighborhood  quarrels,  and  do  not  let 
your  wife  or  any  one  else  know  your  professional  secrets,  or  the 
private  details  of  your  cases,  or  of  the  methods  or  instruments 
used  in  their  treatment,  even  though  they  be  not  secrets.  Few 
persons  like  to  have  their  foibles  retailed  around  from  house  to 
house:  what  they  said  in  their  delirium,  or  how  they  shrank 
from  leech-bites ;  how  she  "  cut  up  "  in  her  labor,  or  he  gagged  at 
a  pill, — or  to  have  other  whims,  fancies,  or  infirmities  exposed. 

"Whispers  often  separate  chief  friends." 

Many  persons  labor  under  the  impression  that  physicians 
who  (injudiciously)  allow  their  wives,  for  the  benefit  of  fresh 
air,  to  ride  around  with  them  while  making  professional  visits, 
relate  to  them  all  that  has  transpired  during  the  visit  after  they 
drive  away.  Such,  of  course,  is  not  the  case;  nevertheless,  if 
people  think  so,  the  discomforting  thought  is  the  same  whether 
it  be  true  or  not. 

There  is  no  end  to  the  mortifications,  compromises,  and 
estrangements  into  which  a  physician's  prying  and  babbling 
wife  may  lead  him  by  her  tittle-tattle.  Notliing  is  more  mor- 
tifying or  vexatious  to  the  feelings  ot  sensitive  patients  than 
to  hear  that  the  details  of  their  cases  are  being  whispered  about, 
as  coming  from  the  physician,  his  trumpet-tongued  wife,  or 
others  whom  he  or  she  has  told. 

If  you  allow  yourself  to  fall  into  the  habit  of  giving  out 
the  latest  inside  news,  or  of  speaking  too  freely  ever  of  ordinary 


HIS    REPUTATION"   AND    SUCCESS.  14^ 

affections,  or  submit  to  be  indiscriminately  interviewed  by  In- 
quisitive Jack  and  Peeping  Jenny,  Mrs.  Knowaheap,  Mrs. 
Blabber,  Mrs.  Picklock,  Longtongue,  and  other  key-hole  nota- 
bles from  Meddlesome  Row,  concerning  your  patients,  your 
very  silence  in  disreputable  cases  will  betray  them.  The  credit 
of  whole  lamilies  and  the  character  of  their  individual  members 
will  sometimes  be  at  stake,  and  unless  you  shut  your  eyes  and 
close  your  mouth,  lest  you  see  and  say  too  much,  it  may  ruin 
them  and  involve  you.  Indeed,  many  persons  would  rather  suffer 
or  even  die  than  be  subjected  to  public  shame  or  disgrace  by  an 
exposure  of  the  affections  they  are  laboring  under ;  and  some 
persons  suffering  with  venereal  diseases  are  so  much  afraid  that 
their  family  physician  might  reveal  the  secret,  that  they  would 
sooner  allow  the  ravages  of  the  disease,  or  apply  to  a  quack, 
than  run  that  risk  of  exposure  and  disgrace. 

You  will  be,  to  a  certain  extent,  an  honorary  member  of 
every  family  you  attend,  and  will  be  allowed  to  see  people  in  a 
very  different  light  from  that  in  which  other  people  see  them, 
when  their  spirits  are  humbled  in  the  hour  of  pain  and  the  day 
of  distress.  The  community,  as  a  rule,  view  one  another  with 
a  veil  thrown  over  their  moral  and  physical  afflictions;  their 
strong  passions  and  feeble  control ;  their  blasted  hopes  and  the 
sorrows  that  flow  from  their  love  and  hatred;  their  poverty, 
their  frailties,  their  crimes,  their  vexations,  and  their  meanness; 
their  cruel  disappointments  and  rude  mortifications,  their  follies 
and  disasters,  fears,  delinquencies,  and  solicitudes.  You  will  see 
the  trappings  of  greatness  and  the  cloak  that  hides  deformity 
dropped,  their  infirmities  and  imperfections  of  mind  and  body 
with  the  veil  uplifted,  and  the  book  of  the  heart  wide  open, — 
the  homeless,  the  betrayed,  the  deserted,  and  the  victims  of 
intemperance,  grief  and  joy,  anger  and  shame,  hope  and  despair. 

"Mouth  shut,  eyes  open." 

You  will  hear  conversations  that  it  would  be  cruel  to  rehearse ; 
you  will  become  the  repository  of  all  kinds  of  moral  and  phys- 
ical secrets.     Keep  them  all,  with  Masonic  fidelity. 


148  THE   PHYSICIAN    HIMSELF: 

Love,  debt,  guilt,  shame,  jealousy,  grief,  domestic  trouble, 
superstition,  poverty,  anxiety,  thirst  for  revenge,  and  the  like 
may  prey  on  the  mind  of  a  sick  person,  and  actually  convert  a 
simple  into  an  incurable  malady.  As  such  matters  are  apt  to 
be  concealed  from  you,  it  is  necessary  that  you  should  bear  in 
mind  that  they  are  important  agents  in  the  causation  and 
intensification  of  disease,  and  be  prepared  for  their  early  recog- 
nition. 

Observe  reticence  at  your  visits,  and  do  not  allude  to  the 
private  affairs  of  anybody  from  house  to  house.  Let  your  lips 
be  hermetically  sealed  to  the  fact  that  So-and-so  has,  or  ever 
had,  venereal  disease,  haemorrhoids,  fistula,  ruptures,  leucorrhoea, 
or  constipation ;  or  that  abortions,  private  operations,  etc.,  have 
taken  place  ;  or  that  any  person  has  recourse  to  anodynes  or 
stimulants ;  or  that  Mrs.  Ohmy  had  a  baby  too  soon  after  her 
marriage,  or  that  Miss  Awfulone  or  Miss  Angelicus  had  one 
without  being  married  at  all ;  or  that  Mr.  Badegg  is  addicted 
to  secret  immoralities,  or  that  Moonlight  or  Sunrise  has  or  has 
had  a  venereal  disease ;  or  that  Allgood  is  not  good  at  all,  but 
has  this,  that,  or  the  other  bad  habit.  No  matter  how  remote 
the  time,  if  patients  wish  their  secrets  told  let  them  be  their 
own  tale-bearer.  You  have  no  right  to  disclose  the  affairs  of 
j)atients  to  any  one  without  their  consent. 

But  while  judicious  silence  should  be  your  general  rule,  it 
is  your  higher  duty  as  a  member  of  society,  and  to  the  laws,  to 
expose  and  bring  to  justice  abortionists, — 

"Tremble,  thou  wretch,  that  hast  within   thee  undivulged  crimes, 
unwliipped  of  justice," — 

unprincipled  quacks,  and  other  heartless  vampires,  whether  act- 
ing under  cover  of  a  diploma  or  not,  whenever  you  meet  with 
proof  of  their  iniquitous  work.  But  (even  though  morally  cer- 
tain thereof)  never  take  a  step  for  which  you  are  not  prepared 
to  be  held  personally  responsible,  and  never  directly  charge  any 
one  with  dishonorable  or  criminal  conduct  on  hearsay  evidence, 
or  unless  you  have  at  hand  ample  and  unequivocal  proof  of  his 


HIS    REPUTATION    AND    SUCCESS.  149 

wrong-doing ;  for,  if  you  are  without  it,  the  accused  is  sure  to 
find  a  loop-hole  of  escape, — 

"It  is  hard  to  catch  a  weasel  asleep," — 

or  to  make  an  indignant  denial,  on  the  principle  that 

My  "  No  "  is  as  good  as  your  "Yes," 

and  cunningly  bring  against  you  a  counter-charge  of  malicious 
persecution,  with  its  legal  consequences ;  after  which  he  will 
•resume — ^increased  business — "a<  the  old  stand.^'' 

In  prescribing  medicines  for  the  sick,  it  is  better  to  confine 
yourself  to  a  limited  number  of  remedies  with  the  power  and 
uses  of  which  you  are  fully  acquainted,  than  to  employ  a  larger 
number  of  ill-understood  ones ;  for  which  reason,  you  will  act 
wisely  in  avoiding  new  remedies  until  their  value  as  remedial 
agents  has  been  satisfactorily  proven.  It  may  also  be  well  to 
remember  that  the  number  of  remedies  actually  required  in 
combating  disease  is  relatively  small. 

Memorize  the  rules  for  dosage,  and  keep  in  mind  the  max- 
imum and  minimum  doses  of  every  article  you  admit  into  your 
list  of  remedies. 

Whenever  you  order  unusually  heavy  doses  of  opiates,  etc., 
instead  of  using  the  common  signs,  take  care  either  to  write  the 
quantity  out  in  full,  or  to  underline  both  the  name  and  quan- 
tity, or  in  some  other  unmistakable  way  show  on  the  prescription 
that  you  are  awake  to  all  that  is  written.  A  good  plan  is  to 
write  at  the  bottom,  "  The  above  is  just  as  intended."  Again, 
when  you  write  for  a  potent  article  that  is  but  seldom  used,  it  is 
well  also  to  add  its  common  name,  that  the  pharmacist  may  feel 
no  doubt  as  to  what  is  intended.  It  is  safer  also  to  put  the 
names  of  heavy-dosed  patients  on  their  prescriptions.  When 
you  order  morphia,  etc.,  in  other  than  the  ordinary  doses,  it  will 
be  well  to  have  it  made  into  pills  and  granules,  and  direct  the 
pharmacist  to  "put  them  into  a  bottle."  It  is  so  unusual  to 
dispense  pills  in  a  bottle,  that  it  intimates  to  the  compounder 
that  the  prescribed  dose  is  not  a  blunder,  but  is  as  intended, 
and  acts  as  a  guard  to  patients  and  attendants  against  taking 


'ISO  THE   THYSICIAN"    HIMSELF: 

or  giving  them  in  mistake.  When  you  prescribe  pills,  powders, 
etc.,  for  sailors  and  other  persons  whose  business  renders  them 
liable  to  get  their  medicines  wet  or  wasted,  it  is  better  to 
direct  them  to  be  put  into  bottles  or  tin  boxes  instead  of  paper 
boxes. 

You  should  have  sufficient  honesty  and  sufficient  independ- 
ence to  do  nothing,  and  to  give  nothing,  to  a  patient  when  that 
is  the  proper  course,  but  you  may  occasionally  come  across  a 
patient  with  disordered  imagination,  who  persists  that  he  is  be- 
witched, or  that  a  pin  or  fish-bone  is  lodged  in  his  throat,  even 
after  your  careful  examination  has  proven  that  there  is  none; 
or  syphilophobic  and  anxious  to  take  constitutional  remedies 
after  a  chancroid ;  or  morbidly  afraid  of  hydrophobia  or  lock 
jaw  ;  or  the  half-insane  victim  of  this,  that,  or  the  other  vagary 
or  hallucination,  and  who  cannot  be  convinced  by  all  your  as- 
surances that  his  ailments  or  forebodings  are  imaginary.  In 
such  a  case,  when  classical  medicine  and  all  else  fails,  as  it  is 
your  object  to  cure,  it  may  become  not  only  justifiable,  but  as 
clearly  your  true  and  manly  duty  to  employ  such  innocent  rem- 
edies as  are  likely  to  relieve  his  heated  and  deluded  imagina- 
tion through  psychological  impressions,  or  the  action  of  mind  on 
mind,  as  it  is  to  give  certain  medicines  for  a  well-defined  dis- 
ease. Any  remedy  or  expedient  honestly  intended  to  excite  a 
definite  expectation,  or  hope,  in  order  to  aid  in  relieving  such 
a  patient,  is  called  a  placebo.  Giving  a  placebo  in  such  a  case 
is  a  very  different  thing  from  practicing  upon  and  increasing  a 
patient's  fears,  as  is  done  by  the  charlatan.  Despise  not  policy, 
but  take  care  that  your  policy  consists  in  honorable  expedients 
for  honest  purposes. 

A  mental  agent  should,  as  a  rule,  be  small  and  easy  to 
take ;  the  bromides,  the  valerianates,  mild  tonics,  and  other 
harmless  remedies  are  sometimes  given. 

Should  you  ever  have  recourse  to  remedies  intended  to  act 
chiefly  through  the  mind,  if  you  will  take  care  to  look  your 
patient  earnestly  and   steadily  in    the   face,   and  give   precise 


HIS   REPUTATION   AND    SUCCESS.  151 

instructions  concerning  the  time  and  mode  of  using  them,  they 
will  do  double  good. 

You  will  not  only  find  that  almost  anything  will  relieve 
some  of  these  mental  cases,  but  will  be  further  surprised  to  learn 
that  it  has  evoked  their  enthusiasm,  and  that  they  are  chanting 
its  praise  and  vowing  that  they  were  cured  of  one  or  another 
awful  thing  by  it.  Some,  indeed,  who  seem  to  be  magically 
benefited  by  doses  of — nothing — will  actually  credit  them  with 
saving  their  lives.  What  a  sad  comment  on  the  boasted  intelli- 
gence of  the  nineteenth  century  !  What  a  pitiable  fact  for  truth 
and  science  that  flavored  water,  etc.,  often  receive  as  much 
(presto,  be  gone  !)  praise  as  the  soundest  remedies  !  What  a 
harvest  such  people  supply  for  those  who  live  by  fleecing ! 

"  Shame  !     Shame  !  !     Shame  !  !  !" 

Of  mental  remedies  make  none  but  an  honest  and  proper 
use  (leave  juggling  and  all  that  is  dishonorable  to  disreputable 
pretenders),  and,  if  you  happen  to  have  the  appropriate  remedy 
give  it  gratuitously  and  charge  for  advice  only ;  if  not,  write  a. 
prescription  for  something  that  is  not  unusually  expensive. 

Never  send  a  patient  to  a  drug-store  with  a  prescription  for 
bread-pills  or  anything  else  you  know  to  be  inert.  It  is  not 
right  to  cause  any  one  to  pay  money  for  articles  that  have  no 
intrinsic  value  ;  besides,  if  among  all  the  simple  tonics,  nervines, 
etc.,  in  the  pharmacopoeia  you  cannot  select  some  recognized 
agent  of  more  remedial  value  to  a  depressed  patient  than  inerts, 
your  resources  must  indeed  be  limited.  Moreover,  if  a  patient 
were  to  discover  that  he  had  not  only  been  paying  money  for 
such  inert,  valueless  articles  as  bread-pills  or  colored  water,  but 
wrongly  exposed  to  the  criticism  and  derision  of  the  pharmacist, 
he  could  not  help  feeling  victimized  and  indignant. 

Let  me  here  impress  a  caution:  to  believe  too  much  and 
not  to  Delieve  at  all  are  both  unfortunate  mental  conditions  ihv 
those  who  practice  medicine.  Take  care  that  your  mind  is  not 
led  into  an  exaggerated  view  of  the  importance  and  power  of 
drugs.     Bear  in  mind  the  example  of  the  old  woman  of  Paris 


152  THE    PHYSICIAN    HIMSELF: 

who  filled  bottles  with  water  from  the  river  Seine,  sold  it  as  a 
cure-all,  and  heard  of  so  many  cures  wrought  by  it  on  all  sides 
that  she  died  fully  convinced  by  a  throng  of  patients  and  a 
bushel  of  certificates  of  cure  that  the  (polluted)  water  of  that 
river  was  a  sure  cure  for  all  the  ills  of  the  human  race.  Guard 
yourself,  also,  against  the  opposite  and  grave  error  that  medicines 
are  useless  and  unnecessary ;  for  either  view  would  materially 
impair,  if  not  destroy,  your  fitness  for  the  practical  duties  of 
your  profession. 

The  very  shape  and  fashion  of  medicine  have  changed  with 
the  present  generation,  and  eight-ounce  bottles  and  thirty-two 
ounce  bowls  of  bad-tasting,  purgative,  expectorant,  or  diapho- 
retic m'edicines,  wasting  the  strength  in  the  beginning  that  is 
needed  during  convalescence,  are  (thank  Providence !)  seldom 
seen,  for  the  vast  majority  of  people  are  now  sensible  enough  to 
avoid  every-day  medicine  taking,  and  to  use  remedies  only 
when  sickness  demands,  and  even  then  not  too  much ;  but 
taking  a  little  "  searching  "  medicine  that  "  scours  "  lour  or  five 
times,  or  a  bottle  of  salts,  or  of  cream  of  tartar,  or  ten  and  ten 
of  calomel  and  jalap  for  "  clearing  the  constitution,"  in  the 
spring  of  the  year,  still  has  patrons,  who  believe  in  positive 
medication  with  positive  results,  just  as  the  good  housewife 
believes  in  spring  and  fall  house-cleaning ;  and  cathartics  and 
other  depleting  remedies  are  still  popular  with  the  few  who  cling 
to  the  old  FORTY- YEARS-AGO  mania  for  purging,  sweating,  and 
cleaning  the  blood. 

Such  people  always  want  to  see  and  feel  promptly  and 
fully  the  action  of  medicines,  and  purge  themselves  entirely  too 
often  ;  and  some  of  them  think  they  could  scarcely  live  a  month 
unless  they  had  almost  turned  themselves  wrong  side  out  with 
pills,  salts,  etc.  Remember  that  when  nature  is  relied  upon 
the  bowels  ought  to  act  daily,  or  at  least  freely  once  in  two  or 
three  days;  for  when  the  bowels  are  naturally  moved,  the  lower 
portion  only  of  the  intestinal  canal  is  cleared  out,  and,  during 
the  interval  before  the  next  evacuation,  the  fsecal  matter  from 


HIS   REPUTATION    AND    SUCCESS.  153 

above  passes  down  and  is  in  turn  evacuated ;  but,  when  a  pur- 
gative is  taken,  it  sweeps  out  the  entire  alimentary  canal,  and 
of  course  such  a  scouring  out  is  not  required  as  often  as  the 
natural,  though  partial  evacuation.  For  any  adult  who  cannot 
have  an  evacuation  without  the  aid  of  medicine,  to  give  an 
aperient  or  purgative  once  in  three  or  four  days  is  sufficiently 
often. 

Never  tell  patients  too  minutely  how  the  prescribed  medi- 
cine Avill  act,  as  it  may  vary  enough  from  your  promise  to  dis- 
appoint them,  and  to  brand  you  as  a  false  prophet.  There  are 
also  a  few  patients  who  would  feel  worried  if  you  were  plainly 
to  tell  them  exactly  what  ails  them. 

Never  solicit  people,  either  by  word  or  otherwise,  to  em- 
ploy you ;  for  such  a  course  would  tend  to  repel  rather  than 
attract  them,  and  could  not  fail  to  deprive  you  of  necessary 
respect  and  esteem.  Besides,  respect  for  yourself  and  the  pro- 
fession make  it  far  better  to  wait  until  your  professional  acquaint- 
ance is  sought. 

Many  people  are  naturally  ackle  and  capricious,  and  can- 
not be  depended  on  to  adhere  to  you,  even  from  one  day  to  the 
next ;  no  matter  how  earnestly  one  tries  to  serve  and  to  satisfy 
them,  they  will  quickly  become  wearied  and  disheartened,  and 
will  insist  upon  consultations  even  in  the  most  trifling  ailments ; 
perhaps,  also,  change  about  with  astonishing  rapidity, — first  from 
one  physician  to  another,  then  maybe  to  a  prescribing  druggist 
or  irregular  practitioner,  and  will  finally  wind  up  with  a  quack 
or  quack  medicine.  Others  will  adhere  to  you  with  steady  con- 
fidence, through  good  and  bad,  with  firm  tenacity.  You  should, 
nevertheless,  under  any  and  all  circumstances,  base  your  hope 
of  being  retained  and  respected,  no  matter  on  what  class  of  pa- 
tients you  are  attending,  upon  the  just  and  true  foundation  of 
deserving  it.  Do  not,  however,  set  your  heart  or  faith  on  a  con- 
tinuance of  the  patronage  and  friendly  influence  of  any  one,  for 
you  will  many  a  time  be  unceremoniously  replaced,  after  days  or 
weeks  of  unremitting  attention,  by  those  whom  you  know  to  be 


154  THE    PHYSICIAN    HIMSELF: 

in  head  and  heart  far  below  you  in  everything  that  constitutes 
a  good  physician.  Sometimes,  after  you  have  shown  every  at- 
tention, spent  days  of  toil  and  sleepless  nights,  and  done  all  that 
is  possible,  you  will  be  unexpectedly  and  unjustly  dropped  by  a 
family  without  reasonable  courtesy  or  explanation,  sometimes  even 
when  the  patient  is  out  of  danger  or  nearly^cured,  and  possibly  be 
superseded  by  Dokter  Lowebb,  or  Prof  Kornkutter,  or  little  Dr. 
Bighead,  or  Docktur  Killcow,  or  Dr.  Bobtail  (who  spends  half 
his  time  in  trading  horses  and  talking  politics),  or  "  an  old 
woman,"  or  an  Irregular,  who  may  at  once  change  your  diagnosis 
of  "  bilious  remittent  fever  "  to  "  malarial  fever,"  or  "  typhoid," 
and  change  your  sulph.  quiniee  and  mass  hydrarg.  to  sulph.  cin- 
chonise  and  hydrarg.  cum  creta,  and  you  have  to  submit  to  the 
humiliation,  the  icy  ingratitude,  and  the  wrong,  without  being 
in  a  position  at  all  to  resent  it,  and  you  will  feel  the  force  of 
Solomon's  soliloquy :  "  If  it  befall  me  as  it  befalleth  to  the 
fools,  why  should  I  labor  to  be  more  wise  ?  " 

"  I  have  seen  a  stately  cedar  foil, 
And  in  its  place  a  mushroom  grow." 

foor  people,  when  raised  to  wealth  (from  the  dirt  to  de- 
lirium), often  move  irom  the  obscure,  old  house,  or  dirty  rooms, 
to  a  mansion  in  a  different  section,  sell  their  old,  shabby  turni- 
ture,  and  buy  new, — 

"But  yesterday  out  of  the  egg,  to-day  they  despise  the  shell," — 

pull  off  plain  clothes  and  put  on  fine  ones ;  and,  as  if  to  efface 
all  the  past,  even  the  physician,  who  attended  them  in  obscurity, 
and  stood  by  them  through  everything,  is  also  abandoned,  and 
Prof  Highkite  or  Dr.  Newmode  is  employed. 

"  And  thus  the  world  goes  round  and  round  ; 
Some  go  up,  and  some  go  down." 

The  faculty  promptly  to  detect  loss  of  confidence,  or  dis- 
satisfaction with  yourself  or  your  remedies,  is  one  of  the  acquire- 
ments which,  if  you  do  not  already  possess,  you  must  seek  to 
acquire.  Bear  in  mind  that  continued  suffering,  protracted  con- 
finement, unsatisfied  suspense,  and  disappointed  expectation  of 


HIS    REPUTATION"    AND    SUCCESS.  155 

convalescence  all  tend  to  produce  impatience  and  dissatisfaction 
in  the  mind  of  the  patient  and  his  friends,  and  to  create  doubts 
of  your  knowledge,  skill,  or  judgment, — for  which  due  allow- 
ance should  be  made. 

Even  to  proclaim  a  truth  is  not  seldom  attended  with 
unpleasant  consequences.  Thus,  you  may  deem  it  your  duty 
to  announce  to  a  patient,  or  to  some  member  of  his  family,  that 
he  has  an  incurable  disease,  or  that  he  will  positively  die.  Un- 
less the  fact  is  obvious  to  all,  you  will  probably  lose  your  patient, 
not  by  his  death,  but  by  his  changing  to  some  other  physician, 
in  the  hope  that  he  may  reverse  your  verdict  and  give  a  more 
hopeful  prognosis.  Hence,  before  you  give  utterance  to  such 
opinion,  make  sure  of  the  facts  upon  which  it  is  based,  for 
a  hopeless  prognosis  deduced  from  insufficient  evidence  will  in- 
flict unnecessary  pain  on  others  and  bring  discredit  on  you. 
Nevertheless,  being  quite  sure  your  judgment  is  correct,  the  pos- 
sibility of  the  patient's  quitting  you  should  not  deter  you  from 
giving  timely  intimation  of  the  state  of  things,  as  it  may  be, 
for  various  reasons,  of  the  highest  importance  that  the  patient 
and  his  family  shall  know  it. 

A  patient  has  a  legal  right  to  dismiss  you  from  a  case  at 
any  time,  but  you  can  very  justly  expect  that  it  shall  not  be 
done  without  cause,  or  without  reasonable  courtesy  and  expla- 
nation; and  you  have  also  a  perfect  right  to  relinquish  attend- 
ance upon  him  at  any  time,  provided  it  be  done  decently  and  in 
order.  Indeed,  you  may  sometimes  find  yourself  so  hampered, 
or  hara  ssed,  or  badly  treated  in  a  case,  that  either  formally  to  re- 
tire from  it  or  discontinue  your  visits  are  your  only  alternatives. 
When  you  discontinue  your  visits,  give  fair  and  timely  notice 
to  the  person  or  persons  chiefly  interested,  that  you  may  not  be 
liable  for  any  had  consequences  of  neglect. 

When  you  find  it  necessary  to  withdraw  from  a  case,  en- 
deavor to  do  so  in  a  courteous  manner,  for  such  withdrawal  does 
not  necessarily  make  it  incumbent  on  you  to  break  off"  all  friendly 
relations  with  the  family. 


156  THE   PHYSICIAN    HIMSELF: 

Whenever  dismissed  from  a  case,  con  over  and  carefully 
reflect  upon  the  various  circumstances  that  conspired  to  produce 
the  dismissal,  and  the  means  by  which  you  might  have  averted 
it,  that,  by  self-analysis  and  self-training,  you  may  acquire  the 
art  of  doing  your  duty  acceptably,  and  thus  retain  your  patients. 

Some  people,  indeed,  who  will  almost  idolize  you  as  long 
as  you  are  lucky  and  have  neither  unfortunate  cases  nor  deaths 
in  their  families,  will,  as  soon  as  either  occurs,  turn  as  rudely 
and  maliciously  against  you,  as  if  you  kept  the  Book  of  Life 
and  could  control  the  hand  of  God. 

When  you  are  unjustifiably  dismissed  from  a  case,  espe- 
cially if  it  be  to  make  room  for  an  Irregular,  or  a  foul  quack,  do 
not  consent  tamely  to  be  cast  aside  in  such  a  manner.  Express 
your  perfect  willingness  to  retire,  but,  at  the  same  time,  make 
it  known,  in  a  courteous,  gentlemanly  manner,  that  you  expected 
fair  play  and  courteous  treatment ;  that  such  dismissal  grossly 
wounds  your  feelings,  casts  undeserved  reflection  on  you,  and 
injures  your  reputation  in  the  eyes  of  the  public,  to  none  of 
which  you  can  be  indifferent.  Such  a  protest  will  not  only 
enable  you  to  vent  your  mortification,  disappointment,  and 
disgust,  but  will  also  secure  for  you  greatly  increased  respect, 
and,  moreover,  tend  more  effectually  to  counteract  any  injury 
likely  to  arise  from  your  dismissal,  than  if  you  meekly  submit 
without  protest. 

In  acutely  painful  cases  of  tetanus,  cholera  morbus,  etc.,  it 
may  be  found  necessary  to  disregard  the  ordinary  rules  of  dosage 
and  give  large,  even  heroic,  doses  of  morphia,  chloral,  or  other 
potent  medicine,  which  must,  moreover,  be  given  promptly,  as 
hours,  or  even  minutes,  may  decide  the  result ;  care  must,  of 
course,  be  taken  that  the  total  quantity  be  within  the  limits  of 
safety,  and  not  sufficient  to  poison  the  patient.  The  following 
case  will  illustrate  the  point:  A  gentleman  known  to  the 
author  had  a  bad  case  of  cholera  morbus;  a  physician  was 
called,  who  prescribed  for  him  twelve  opium  pills,  one  to  be 
taken  every  six  hours.     In  that  case  the  physician  was  fatally 


HIS    REPUTATION    AND    SUCCESS.  157 

slow  in  his  therapeutics,  for  long  before  the  time  to  take  the 
second  pill  had  arrived  the  soul  of  that  pain-racked  sufferer  had 
taken  its  flight  to  a  land  where  medicine  is  not  needed  and  six- 
hour  intervals  can  do  no  harm.  Take  care  to  avoid  his  error, 
and  never  leave  long  intervals  between  the  doses  for  patients 
suflering  acute  pain. 

Bear  in  mind  tliat  an  opiate  that  has  power  to  relieve 
acute  pain  will  do  so  within  an  hour  ;  failure  to  do  so  necessi- 
tates a  second  or  third  dose.  A  dose  of  chloral  will  produce 
sleep  within  half  an  hour  or  so.  if  at  all,  and  it  is  useless  to 
wait  longer  before  repeating  it.  When  it  is  intended  to  keep  a 
patient  under  the  influence  of  opiates,  it  is  necessary  to  repeat 
them  every  four  hours  or  so,  inasmuch  as  the  effects  of  a  dose 
begin  to  wear  ofl"  after  that  time. 

When  opiates  are  no  longer  needed,  the  nausea  that  might 
follow  their  abrupt  withdrawal  may  be  prevented  by  continuing 
them  in  decreased  doses  at  four-hour  intervals,  decreasing  the 
dose  each  time  to  one-half  of  the  preceding  one. 

There  is  a  popular  belief  that  opiates  are  given  only  to 
allay  or  relieve  pain,  not  to  cure  the  sickness.  People  should  be 
made  to  understand  that  opiates  are  not  only  palhatives,  but  by 
controlling  pain,  lessening  functional  activity,  etc.,  they  are 
powerful  curatives  in  a  long  list  of  diseases. 

You  will  often  recognize  the  character  of  a  case,  or  see 
the  patient's  exact  condition,  before  you  ask  a  single  question ; 
yet  the  laity  expect  you  to  examine  your  patient  at  every  visit. 
Let  your  first  examination  be  careful  and  thorough ;  omit 
nothing  that  can  shed  light  on  the  case,  and  never  neglect  the 
following  five  cardinal  duties :  to  feel  the  pulse,  to  examine  the 
tongue,  and  to  inquire  about  the  appetite,  the  sleep,  and  the 
bowels.  No  matter  what  the  case  may  be,  take  care  to  attend 
to  these  and  all  other  evident  or  special  duties  at  every  visit,  else 
the  patient  may  think — in  your  rush  and  hurry — he  has  not 
gotten  the  worth  of  his  money,  or  is  not  properly  attended. 

Whenever  symptoms  render  it  probable  that  hernia,  carci- 


158  THE    PHYSICIAN    HIMSELF: 

noma  uteri,  Blight's  disease,  or  heart  disease  is  present ;  or  that 
tlie  throat  is  diphtheritic,  or  the  ear  occluded  by  wax  ;  or  that 
a  tumor  or  an  aneurism  exists ;  or  that  one's  femur  is  fractured 
within  the  capsuhir  hgament,  or  his  shoulder  dislocated;  or 
that  a  patient  is  pregnant,  or  has  placenta  prsevia,  or  a  uterine 
polypus ;  or  fissure  of  the  anus,  or  fistula ;  or  that  any  other  con- 
dition exists  which,  if  overlooked,  might  cause  unnecessary  suffer- 
ing or  imperil  the  patient's  life,  and  possibly  consign  you  to  the 
never-dying  goadings  of  remorse  for  having  overlooked  a  patent 
fact,  or  committed  a  grave  mistake,  or  subject  you  to  humilia- 
tion and  disgrace,  if  discovered  by  another,  who  has  come  in, — 
all  mind,  all  heart,  all  eye,  all  ear,  all  touch, — determined  to 
show  the  wisdom  of  .his  being  called,  you  should  always  make 
an  immediate  and  thorough  examination,  and,  if  need  be, 
gently  hint  to  the  patient  or  to  the  friends  your  suspicions  and 
apprehensions. 

"  Too  late,  too  late's  the  curse  of  life." 

If  you  are  careless  or  neglectful  in  these  matters,  you  will 
often  be  surprised  to  see  another,  who  has  been  called  in  con- 
sultation, or  who  has  superseded  you,  discover  the  whole  truth 
of  tlie  case;  not  so  much  from  his  superior  skill,  but  because  he 
made  some  examination  or  inquiry  that  you  omitted.  One  of 
the  most  certain  signs  of  a  good  and  conscientious  physician  is. 
to  make  an  earnest,  long-continued,  and  careful  examination  of 
the  patient. 

To  mistake  a  tumor  for  pregnancy,  or  vice  versa,  is  one  of 
the  most  mortifying  and  personally  damaging  errors  of  judg- 
ment that  can  well  be  made.  To  be  attending  a  female  W'ho 
has  been  ailing  for  weeks  and  months,  and  who  finally  proves 
to  be  pregnant,  is  also  very  damaging,  unless  you  have  recog- 
nized and  declared  that  fact ;  otherwise,  her  entire  illness  will  be 
attributed  to  tlie  pregnancy.  In  such  cases  some  demur  will 
probably  be  made  to  the  payment  of  your  fees. 

Never  ask  an  unnecessary  question,  yet  be  careful  to  make 
every  inqniry  essential  to  ascertain  all  the  facts,  and  to  satisfy 


HIS    REPUTATION    AND    SUCCESS.  159 

the  patient  and  others  that  you  feel  an  interest  in  his  case;  if 
you  neolect  to  do  so,  vou  will  risk  both  an  error  and  loss  of 
confidence. 

Prompt  detection  of  dangerous  changes,  or  of  the  approach 
of  death,  will  not  only  shield  you  from  blame,  but  will  giye  you 
a  certain  kind  of  prestige  if  you  point  them  out  before  the 
patient  or  his  friends  observe  them. 

Be  careful  never  to  speak  of  anything  you  may  do  for  a 
patient  as  an  experiment  or  from  curiosity;  for  everybody  is 
more  or  less  opposed  to  physicians  "trying  experiments"  upon 
themselves  or  theirs.  For  the  same  reason,  it  is  unwise  to  give 
patients  the  sample  bottle  of  new  remedies  sent  to  you  for  trial, 
or  to  let  any  one  know  that  he  is  the  first  to  whom  you  ever  gave 
this  or  that  medicine ;  or  that  his  is  the  first  case  of  the  kind  of 
fracture,  or  of  small-pox,  or  of  hernia,  or  of  anything  else  you 
ever  attended,  or  suspicion  may  take  the  place  of  confidence. 

You  should  keep  a  register  or  a  reference-book  for  collect- 
ing and  retaining  particularly  good  remedies,  prescriptions  for 
stubborn  diseases,  medical  clippings,  self-devised  apparatus  and 
expedients,  self-discovered  facts,  and  important  things  that  you 
have  seen,  heard,  read,  or  thought, — the  substance  of  all.  Such 
a  record  possesses  continual  interest  and  more  value  to  its 
owner  than  any  other  book  in  his  library ;  also  a  clinical  case- 
book or  a  diary  for  recording  the  date,  diagnosis,  treatment;, 
etc.,  of  unusually  important  cases.  Nothing  impresses  a  patient 
suffering  from  a  complicated  or  long-standing  disease  with  a 
conviction  that  you  feel  an  interest  in  him,  and  intend  to  try 
your  utmost  for  him,  so  much  as  to  know  that  you  keep  a  daily 
or  other  regular  record  of  his  case.  Besides,  these  records  will 
become  a  store-house  of  facts,  and  furnish  you  important  cases 
for  relation  at  the  societies  or  for  publication  in  the  joiu-nals. 

When  truth  will  allow,  let  your  diagnosis  either  include 
the  patient's  belief  or  fully  disprove  it,  that  his  mind  may  not 
distrust  your  opinion  and  treatment,  and  so  tend  to  counteract 
your  treatment. 


160  THE    PHYSICIAN    HIMSELF.* 

You  can  more  easily  impress  and  permanently  convince  a 
doubting  patient  of  a  medical  fact  which  militates  against  his 
wish  or  belief — for  instance,  that  shortening  is  usual  after 
fracture — by  showing  it  to  him  in  the  books  than  by  a  hundred 
of  your  own  verbal  statements. 

Demonstrations  to  a  patient  or  his  friends  of  certain  diseases 
and  injuries  that  admit  of  it,  by  comparing,  in  plain  language, 
the  affected  parts  to  sound  ones  on  a  well-drawn  pencil-sketch 
or  diagram  on  a  prescription  paper,  and  patiently  explaining 
simple  facts  that  are  not  clear  to  them,  gives  great  satisfaction, 
and  makes  them  appreciate  that  you  understand  the  case. 

Study  to  be  fertile  in  expedients,  and  be  very,  very,  very 
slow  to  confess,  or  allow  the  inference,  that  you  are  hopelessly 
puzzled  about  a  case,  are  at  your  wit's  end,  or  have  reached  the 
limit  of  your  resources. 

Never  be  too  sanguine  of  a  patient's  recovery  from  a  serious 
affliction,  and  never  give  one  up  to  die  in  acute  disease  unless 
the  process  of  dissolution  be  actually  in  progress.  Wiseacres  say 
that  "  the  only  way  to  get  well  after  a  physician  gives  one  up  is 
to  give  him  up  "  (I).  Above  all  else,  never  withdraw  from  a 
case  of  acute  or  self-limiting  disease  because  the  patient  is  very 
ill,  or  seems  as  cold  as  ice,  and  more  likely  to  die  than  to  live ; 
for  the  human  system  can  often  endure  a  great  deal  and  still 
live  ;  besides,  it  is  always  highly  comforting  to  anxious  relatives 
or  friends  to  know  that  the  physician,  with  his  strong  arm,  kindly 
stands  as  a  stay  and  support,  ready  and  willing  to  do  more,  if  the 
slightest  opportunity  occurs. 

Icy  coldness  sometimes  seems  to  make  death  inevitable 
within  a  few  hours,  and  the  physician  hastens  to  announce  it, 
when  lo  !  reaction  and  high  fever  appear,  whip  up  and  revive 
the  failing  powers  again,  and  make  it  seem  as  if  he  lost  hope 
and  abandoned  the  patient  several  days  too  soon. 

If  a  patient  be  unable  to  swallow,  think  of  the  oesophageal 
tube ;  or  if  food  taken  into  the  stomach  be  not  assimilated,  con- 
tinue your  efforts  with  inunctions  of  codliver-oil,  or  oil  and  quinia; 


I 


HIS   REPUTATION    AND    SUCCESS.  161 

also,  by  rectal  alimentation,  hypodermatic  injections,  etc.,  until  he 
is  either  better  or  the  breath  is  out  of  his  body ;  for  nature,  by 
a  crisis,  or  a  vicarious  function,  or  a  compensatory  process,  or 
even  the  tardy  action  of  the  remedies  you  have  already  used, 
may  turn  the  scale  and  let  the  life-power,  or  the  special  vitality 
of  a  vigorous  constitution,  rally  and  gain  control  over  the  dis- 
ease at  the  very  last  hour.  Under  such  circumstances,  if  you 
have  hastily  given  up  the  case,  and  ingloriously  abandoned  the 
patient  as  hopeless,  you  will  be  justly  mortified,  while  some 
brother-physician  or  an  Irregular,  or,  may  be,  an  old  woman, 
who  has  stepped  into  the  field  at  the  lucky  moment,  will  reap 
the  glory  of  setting  the  laws  of  nature  aside,  and  bringing  back 
to  life  one  already  given  up  as  dead. 

u 


CHAPTER  VI. 

"  He  is  most  free  from  danger  who,  even  when  safe,  is  on  his  guard." 

You  will  have  to  be  on  your  guard  against  thousands  of 
snags,  pitialls,  and  rocks,  which  lie  hid  in  the  paths  and  under 
currents  to  entrap  and  upset  the  unwary.  When  in  doubt 
whether  duty  requires  you  to  do  a  thing  or  not, — for  instance, 
between  doing  nothing  and  a  dangerous  operation, — if  all  else 
be  equal,  remember  that  the  sin  of  omission  is,  in  appearance  at 
least,  not  so  great  as  the  sin  of  commission. 

A  very  safe  guide,  in  determining  what  line  to  pursue  in 
grave  or  puzzling  cases,  is  to  imagine  yourself  to  be  in  the 
patient's  dilemma,  and  then  earnestly  ask  yourself.  What  would 
I  have  done  1 

We,  of  all  men,  need  to  be  as  wise  as  serpents  and  as  harm- 
less as  doves.  The  most  skillful  physician  may  and  often  does 
get  results  that  he  deplores  almost  as  much  as  the  patient  does, 
but  wliich  his  sincerest  desu'es  and  every  care  and  his  best  judg- 
ment are  powerless  to  prevent ;  therefore,  in  all  ugly  fractures, 
in  capital  operations,  and  all  other  serious  cases,  be  they 
what  they  may,  in  which  you  think  there  is  any  danger  of  an 
unsatisfactory  termination,  and  of  your  being  blamed  or  sued  in 
consequence  for  the  result,  never  hesitate  to  seek  professional 
aid.  Having  a  second  physician  not  only  divides  the  great 
responsibility,  but  also  constitutes  each  a  witness  of  truth  for  the 
other,  and,  by  making  each  the  guardian  of  the  other's  charac- 
ter, will  tend  to  divert  hostile  criticism,  charges  of  unskillfulness, 
or  of  mis-diagnosis,  and  causeless  suits  for  malpractice : — 

"Much  caution  does  no  harm." 

Keep  in  view,  moreover,  that  the  general  community  have 

the  idea  that  physicians  can  and  should  restore  broken  bones 

and  injured  tissues,  no  matter  what   the  injury  may  be,  as  per- 

fectlv  as   the  Creator   made   them.     Bear   in   mind,   also,  that 

(162) 


HIS    REPUTATION    AND    SUCCESS.  16o 

when  a  fracture,  or  dislocation,  or  disfiguring  wound,  or  acci- 
dent of  any  kind,  results  in  deformity,  or  shortening,  or 
disablement, — contracted  tendons,  or  rigid  cicatrices,  or  a  limp, 
or  requires  a  cane  or  crutch, — there  is  danger  of  its  being- 
shown  ever  after  as  a  botch  or  failure,  and  becoming  a  lasting 
and  lingering  libel  on  the  reputation  of  the  medical  attend- 
ant, A  badly  set  limb,  or  an  unnecessary  or  bungling  am- 
putation, injures  our  whole  profession,  and  the  limb  or  stump 
may  be  held  up  in  court  in  a  suit  for  damages ;  therefore,  the 
responsibility  had  better  be  divided.  In  this  respect  medical 
and  surgical  practice  differ, — the  results  of  sickness  usually  dis- 
appear, while  those  of  unsuccessful  or  unfortunate  surgery 
remain,  and,  if  bad,  may  induce  jealous  rivals,  tricky  lawyers, 
or  other  conspirators  to  incite  the  patient  to  cast  you  into  the 
fiery  furnace  of  a  lawsuit.  Juries  place  a  high  estimate  on  the 
value  of  life  and  limb  when  sacrificed  by  supposed  negligence 
or  want  of  skill. 

Among  the  reasons  why  many  malpractice  suits  spring  from 
surgical  cases,  and  but  few  from  medical  ones,  are  these : 
Although  one  is  as  liable  to  a  prosecution  by  the  laws  for  medi- 
cal as  for  surgical  malpractice,  it  happens  that  medical  cases 
are  treated  in  a  more  private  manner,  and  may  each  be  treated 
in  numerous  ways, — some  the  very  opposite  of  others, — and  we 
are  not  compelled  to  give  an  exact  name  to  every  form  and 
feature  of  disease,  and  a  logical  reason  for  every  plan  of  treat- 
ment pursued ;  and  persons  interested,  even  though  dissatisfied 
with  the  result,  are  not  competent  to  judge  of  the  physician's 
skill  and  treatment  to  the  extent  of  a  lawsuit ;  whereas,  the 
amputation  of  limbs,  the  adjustment  of  fractures,  the  reduction 
of  dislocations,  the  management  of  wounds,  bandaging,  etc.,  all 
depend  on  a  knowledge  of  anatomy  and  on  manipulative  dex- 
terity, and  are  all  open  to  public  observation  and  criticism  ;  and 
the  methods  proper  to  pursue  in  any  case  are  so  well  agreed 
upon  by  surgeons,  and  the  results  aimed  at  are  so  obvious,  that 
even    the    vulgar  may  criticise  and    also    prophesy.      Having 


164  THE    PHYSICIAN    HIMSELF: 

anatomy  for  his  foundation  and  the  science  of  surgery  for  his 
guide,  the  surgeon  is  expected  to  follow  certain  definite  rules, 
to  have  infallible  foresight,  to  overcome  all  surmountable  diffi- 
culties, and  to  get  a  perfect  result.  If  he  does  this,  eclat  awaits 
him,  but  if  he  gets  a  bad  result,  and  is  presumed  to  have  omitted 
any  duty,  the  painful  task  of  vindicating  himself  against  a  law- 
suit may  follow. 

The  sooner  your  accoulit  with  a  dissatisfied  patient  is 
settled  in  one  way  or  another,  after  your  services  are  no  longer 
required,  the  less  likely  you  will  be  to  have  a  lawsuit ;  and,  if 
you  do  have  one,  the  sooner  after  the  services  are  rendered  the 
better,  while  witnesses  are  still  accessible  and  all  the  unfavorable 
influences  are  fully  remembered. 

Bear  in  mind  that  you  have  no  right  to  do  more  to  a 
patient  under  anaesthesia  than  it  was  agreed  to  do.  To  put  a 
patient  under  chloroform  to  amputate  a  finger,  or  to  remove  an 
eye,  and  then  to  amputate  the  whole  hand  or  both  eyes,  would 
give  great  reason  for  blame. 

Keep  your  surgical  knowledge  at  your  fingers'  ends ;  medi- 
cal cases  can  be  read  up  as  they  progress,  but  a  broken  limb,  or 
a  dislocated  bone,  or  a  wound,  will  not  wait,  and  you  must  be 
ever  ready  to  treat  them  correctly ;  and  never  forget  that  band- 
ages, either  too  tightly  applied  or  under  which  the  tissues  have 
swollen  and  constricted  the  circulation,  have  always  been  a 
fruitful  source  of  blame  and  of  lawsuits. 

Always  take  the  precaution,  as  well  for  your  own  as  for  the 
patient's  protection,  to  examine  carefully  the  action  of  the  heart 
immediately  before  administering  an  anaesthetic ;  and  to  watch 
the  respiration  during  the  administration, — withdrawing  the 
agent  on  the  least  approach  of  blueness  of  the  face  or  lips. 
Take  care  to  have  another  physician  or  a  reliable  assistant  pres- 
ent in  all  cases  in  which  it  is  necessary  to  produce  anaesthesia, 
more  especially  if  the  patient  be  a  female ;  and  be  ready  to 
hang  the  patient  head  downward  the  moment  weakening  of  the 
heart's  action,  or  of  respiration,  or  narcotism,  requires.     Also, 


HIS   REPUTATION    AND    SUCCESS.  165 

have  a  third  person  present  at  all  sexual  examinations  of 
females,  especially  if  at  your  office,  to  disprove  possible  halluci- 
nations regarding  either  improper  language  or  actions,  and  to 
protect  against  scandal  and  the  traps  of  designing  people : — 

"An  enem)'^  has  sharp  eyes  and  acute  ears." 

Here,  I  may  say,  beware  of  personal  violence.  Midnight 
desperadoes  may,  under  pretence  of  sickness,  decoy  you  into 
their  traps,  and  then  rob  or  murder  you ;  or  your  brute,  crazy 
with  drink ;  or  your  homicidal  maniac ;  or  your  fever-tossed 
patient  who  knows  not  what  he  does ;  or  your  lunatic  with  a 
delusion ;  or  the  infuriated  fellow  in  whom  you  have  made  a 
wrong  diagnosis  or  had  a  mistjake  in  the  medicine ;  or  the  un- 
reasoning tiger  in  whose  family  you  have  had  sad  deaths,  or  an 
unfortunate  case  of  surgery,  or  of  unsatisfactory  midwifery ;  or 
the  insane  wretch  whom  you  have  through  kindness  sent  to  an 
asylum ;  or  the  disappointed  and  desperate  would-be  suicide 
whom  you  have  restored ;  the  blackguard,  the  thug,  the  fanatic, 
the  madman, — any  blood-thirsty  demon  or  member  of  the  dan- 
gerous class  may  suddenly  assault  and  try  to  maim  or  kill  you. 

You  will  not  only  have  frequent  lucky  coincidences,  which 
Avill  give  you  unearned  credit,  but  also  occasional  unlucky  coin- 
cidences, in  which  the  most  unwelcome  events  will  follow  your 
therapeutics  so  closely  as  to  seem  to  be  due  to  them.  Be  ever 
ready  to  explain  and  defend. 

All  anaesthetics  are  dangerous ;  refuse  to  give  them  in 
trifling  cases  of  minor  surgery,  or  where  a  moment's  fortitude 
on  the  part  of  the  patient  is  all  that  is  required.  Such  occasions 
do  not  justify  the  risk. 

Never  examine  a  female  to  ascertain  whether  she  is  illicitly 
])regnant,  at  the  instance  of  parents  or  others,  without  her  own 
lull  consent  to  the  proceeding. 

Such  exclamations  as  "  Oh  no,  Doctor !  it  cannot  be  that 
liis  arm  (or  leg)  is  broken,  for  he  can  work  his  fingers  (or 
toes)"  will  often  greet  you  when  you  pronounce  that  a  bone  is 


166  THE    PHYSICIAN    HIMSELF: 

fractured.  This  error  is  due  to  the  fact  that  people  think  that 
the  fingers  and  toes  are  moved  by  the  bones  instead  of  tlie 
muscles.  It  sometimes  becomes  necessary  to  explain  this  in 
defense  of  the  opinion  you  have  expressed,  or  to  silence  some 
dissenter ;  every  one  can  move  his  tongue,  which  has  no  bones. 

Patients,  especially  those  of  the  fair  sex,  whether  virgin, 
wife,  or  widow,  sometimes  decline  to  allow  the  physician  to 
make  examinations  that  necessitate  uncovering  the  body,  or  to 
allow  him  to  see  the  underclothing  or  body,  simply  because  they 
are  unclean  and  unfit  to  be  seen,  while  the  physician  erroneously 
supposes  that  the  refusal  is  dictated  by  overshyness  or  modesty 
on  account  of  the  examination.  In  many  such  cases  it  is  better, 
instead  of  insisting  on  an  immediate  examination,  to  respect 
their  delicacy,  or  comfort,  or  convenience  in  the  matter,  and 
defer  it  to  another  time,  to  afford  the  desired  opportunity  for  a 
change  of  linen,  etc. 

Occasionally,  some  suspicious  father,  or  curious-minded 
husband,  will  show  a  determination  to  remain  in  the  room  dur- 
ing vaginal  examinations,  or  during  operations  necessitating 
exposure  of  his  wife's  body,  and  you  will  feel  tempted  to  ask 
him  to  retire,  that  he  may  escape  the  indelicate  sight  and  you 
the  embarrassment.  If  asked  to  retire,  one  or  another  might 
refuse  to  go,  or  do  so  with  suspicious  anger.  The  better  plan 
in  such  cases  is  to  inform  the  person  that  you  are  about  to  begin 
what  your  delicate  duty  requires  you  to  do,  and  he  will  prob- 
ably retire  of  his  own  accord,  unless  specially  requested  to 
remain.  In  the  event  of  his  antagonistic  refusal  to  leave,  it 
may  become  a  question  whether  to  proceed  with  the  examination 
or  operation,  or  to  abandon  or  defer  it. 

Expertness  in  detecting  and  contravening  the  various  kinds 
of  scandal  and  calumny  admits  of  cultivation  to  a  great  degree ; 
so  also  does  the  ability  to  foresee  and  avoid  entanglement  with 
the  captious,  the  mischief-maker,  the  silly  tattler,  the  malicious 
liar,  and  the  like. 

Key-hole   and   back-window   scandal-mongers,  and  lying 


HIS    REPUTATION    AND    SUCCESS.  167 

snakes  in  the  grass,  may  also  lie  in  ambush  for  you,  trying  to 
make  something  or  mucli  out  of  little  or  nothing : — 

"Much  broth  is  often  made  of  little  meat." 

These  must  be  met  and  checkmated  by  the  most  available 
means.  To  judge  what  is  best  to  be  done  under  the  circum- 
stances is  at  times  a  most  annoying  and  puzzling  question  to  be 
confronted. 

Jealous  midwives,  chattering  nurses,  ignorant  doctor- 
women,  busy  neighbors,  and  Job's  comforters  often  exert  a 
malign  influence  on  patients,  and  tell  tales  and  give  instances 
of  ignorance  and  of  lack  of  attention,  and  circulate  damaging 
falsehoods  and  rumors  about  physicians,  that  must  be  noticed 
and  coped  with  according  to  the  necessities  of  the  case,  but 
neither  malice  nor  envy  can  do  you  any  harm  unless  your  own 
misdeeds  prepare  the  way. 

Tact  and  nice  discernment  in  establishing  and  maintainhig 
a  proper  attitude  toward  nurses  and  other  attendants  on  tlie 
sick  is  a  valuable  power  that  will  prevent  or  counteract  many 
possible  machinations.  Love  of  approbation  is  natural ;  and  to 
give  attendants  due  credit  on  fitting  occasions  for  the  faithful 
discharge  of  their  duty  is  not  only  just  and  gratifying  to  them, 
but  tends  to  make  them  your  firm  friends.  Such  public  in- 
dorsement, moreover,  secures  their  further  co-operation,  and 
encourages  them  to  do  their  best  to  maintain  the  reputation 
which  you  have  given  them. 

A  bad  or  ignorantly  careless  nurse  may  render  a  curable 
case  fatal  by  improperly  indulging  the  patient's  appetite  for 
food  or  drink,  or  by  neglecting  to  give  him  medicine,  drink, 
diet,  etc.,  at  the  proper  time,  or  in  the  manner  directed ;  or  by 
appropriating  his  food  or  robbing  him  of  the  stimulants  directed 
to  be  given ;  or  by  subjecting  him  to  excessive  heat  or  cold, 
or  giving  him  too  much  or  too  little  fresh  air ;  or  by  getting 
drunk,  or  becoming  careless,  etc. 

The  conciliation  of  anxious,  captious,  impatient,  or  dissatis- 
fied friends  of  the  sick,  when  the  sickness  is  not  progressing 


168  THE    PHYSICIAN   HIMSELF: 

satisfactorily,  requires  no  little  skill  and  a  comprehensive  study 
of  human  nature. 

In  serious  or  rare  cases,  and  particularly  in  such  as  engen- 
der great  neighborhood  or  general  excitement,  if  you  indulge  in 
confidential  or  semi-confidential  whispers  to  the  people  or  rab- 
ble, as  the  case  may  be  ;  or  incautiously  give  out  daily  bulletins 
to  them  regarding  the  patient's  pulse,  temperature,  respiration, 
excretions,  discharges,  etc.,  it  will  often  give  rise  to  misrepresen- 
tation, or  even  to  utter  perversion  of  what  you  really  did  say  or 
mean,  and  your  statements  may  come  back  to  you  so  changed 
as  to  necessitate  tedious  and  irksome  explanations  from  you. 
You  will  act  wisely,  therefore,  in  being  ever  on  the  alert  to 
avoid  danger.  If  it  be  necessary,  express  your  opinion  briefly 
to  the  proper  persons,  in  writing,  with  the  view  to  prevent  its 
being  misrepresented  or  perverted. 

When  a  sick  person  puts  himself  under  your  care  he  gives 
you  a  responsible  duty  to  perform,  and  he  has  no  right  to  ask 
your  advice  without  a  sincere  intention  of  following  it ;  for  if 
he  then  neglect  or  refuse  to  use  your  remedies,  or  obeys  your 
instructions  in  a  half-way  or  imperfect  manner,  he  ties  your 
hands  and  frustrates  your  efi"orts  for  his  relief,  and  cannot  hold 
you  to  full  responsibility  in  the  case.  If,  however,  he  will  not 
or  can  not  do  exactly  as  you  wish,  and  if  no  special  danger  ex- 
ist, it  is  sometimes  better,  after  drawing  attention  to  the  position 
in  which  you  are  placed  (as  a  protection  to  yourself),  to  humor 
his  antipathies,  whims,  or  childish  weaknesses,  and  modify  or 
alter  your  therapeutics  so  as  to  meet  his  wishes  and  ability. 
This  you  can  do  in  a  good-natured  way,  without  fully  yielding 
to  him  or  compromising  your  authority  or  dignity.  The  wishes, 
prejudices,  impulses,  and  erroneous  views  of  exceptional  and 
fastidious  patients  must  be  studied  and  to  a  certain  extent 
respected.  To  do  this  is  a  matter  of  policy,  and  is  very  dif- 
ferent from  yielding  a  question  of  principle.  But  if  a  patient 
be  determined  to  use  an  improper  or  dangerous  agent,  you 
should  of  course  refuse  your  sanction ;  or  where  you  find  it 


HIS   REPUTATION    AND    SUCCESS.  169 

impossible  to  secure  a  faithful  observance  of  your  directions  on 
the  part  of  the  nurse,  or  where  they  are  bent  on  trying  the 
latest  nostrum,  it  may  then  become  your  duty  to  consider 
whether  to  go  on  with  the  case  or  retire : — 

"  Two  captains  siak  the  ship." 

Never  captiously  oppose  a  remedy  because  it  is  suggested 
by  a  layman.  An  amateur  nurse  or  the  most  ignorant  person 
may  make  a  wise  suggestion  ;  and  laymen  often  talk  excellent 
sense  about  medical  facts  which  have  come  to  their  notice. 
Listen  patiently  to  all  sensible  propositions,  and,  if  simple  and 
unobjectionable,  you  may  find  it  judicious,  if  only  for  tlieir 
moral  effect,  to  utilize  them  in  conjunction  with  your  own  par- 
ticular treatment.  Be  frank  in  giving  credit  to  any  good  idea, 
no  matter  by  whom  advanced ;  and  when  rejecting  a  remedy 
thus  tendered,  let  it  be  known  that  your  disapproval  thereof 
arises  from  conviction  and  not  from  superciliousness.  You  mav, 
also,  in  some  cases  humor  a  whim  and  sanction  the  use  of  harm- 
less domestic  (Grandmother)  remedies, — herb-tea,  mustard  and 
other  plasters,  onions  to  the  feet,  etc.,  in  conjunction  with  your 
more  reliable  agents. 

Make  it  a  rule  to  accord  persons  credit  for  well-meant 
deeds,  even  though  they  be  valueless  in  themselves ;  also,  when 
possible,  to  approve  domestic  treatment  adopted  before  you  were 
sent  for ;  at  least,  do  not  condemn  it  in  a  violent  or  offensive 
manner.  Listen  patiently  to  those  around  while  they  relate 
how  they  did  the  best  they  knew,  and  do  not  pooh-pooh,  shrug 
your  shoulders,  or  smile  sarcastically,  and  thus  unfeehngly  be- 
little their  honest  efforts  to  relieve  the  sufferer. 

"Be  to  their  faults  a  little  blind, 
And  to  their  virtues  very  kind." 

Your  cordial  approval  of  their  simples,  used  in  good  faith 
witli  true  and  loving  motives,  will  greatly  redound  to  your 
credit,  and  greatly  enhance  your  reputation  for  kindness  and 
sympathy. 

When  attending  certain  classes  of  seriously  ill    patients. 


170  THE   PHYSICIAN    HIMSELF: 

e.g.^  the  wife  of  a  druggist  or  the  child  of  a  physician,  if  there 
be  any  simple  remedy  in  which  they  have  great  faith  and  which 
they  wish  to  try,  every  consideration  should  incline  you,  unless 
there  is  some  clear  contra-indication,  to  freely  acquiesce  and 
allow  it,  in  conjunction  with  your  other  means. 

It  will  be  a  trying  ordeal  when,  by  accident,  you  meet  an 
"  old  lady  who  has  a  never-failing  salve,"  good  for  everything, 
from  mosquito-bites  up  to  tuberculosis.  You  will  find  her  so 
full  of  faith  in  herself  and  in  her  great  catholicon  that  neither 
reason  nor  ridicule  can  shake  it.  Be  fair  and  .reasonable  with 
her,  and  treat  her  with  courtesy  and  respect ;  but  if  you  feign 
an  attack  of  awe,  or  indiscreetly  chop  logic  with  her,  and  con- 
cede to  her  remedy  any  recognition  beyond  its  actual  merits,  or 
meet  her  as  an  equal  and  take  her  into  confidence  or  semi- 
partnership  in  the  treatment  of  felons,  ulcers,  or  wounds,  you 
will  make  a  mistake,  and  fill  her  matronly  head  as  full  of 
conceit,  and  of  mischief,  too,  as  the  sea  is  of  water. 

Cultivate  the  quality  of  being  a  good  listener,  and  let  a 
patient  tell  his  story  in  his  own  way,  even  though  it  be  unneces- 
sarily prolix  or  tedious.  Hypochondriacs,  who  live  in  an  end- 
less midnight  of  gloom,  the  hysterical,  the  garrulous,  the  slightly 
insane,  and  various  other  kinds  of  incorrigible  bores,  who  want 
you  to  "  subscribe  "  for  them,  or  who  have  become  "  manured  " 
to  suffering,  and  want  to  "  insult "  you  on  their  cases,  because 
they  have  heard  you  are  a  good  "  musician ;"  chronic  wrecks, 
perpetual  invalids,  and  troublesome  "  old  women  of  both  sexes  " 
with  a  low  level  of  health,  looking  ever  on  the  sad  side  of  life, 
will  sometimes  come  to  your  office,  and  want  to  murder  your 
time  with  annoying  or  unnecessary  questions,  or  exaggerated 
descriptions  of  their  ailments,  for  which  a  whole  apothecary 
shop  might  be  vainly  prescribed ;  or  to  persecute  you  with  the 
details  of  their  business  or  their  ancestry,  or  the  history  of  their 
family  affairs,  with  a  whole  Pandora's  box  of  sighs  and  laments 
added,  when  you  have  no  time  to  waste  and  yet  are  indisposed 
to  be  rude ;  and  then  tarry  so  long  after  the  consultation  is 


HIS    REPUTATION    AND    SUCCESS.  171 

ended  and  the  prescription  given  that  you  actually  wish  you 
could  rise  in  your  chair,  make  a  polite  bow,  and  open  the  exit 
door,  else  fly  out  at  the  window  and  escape  from  them. 

Some  of  these  you  will  have  to  freeze  out  by  chilling  cold- 
ness in  their  reception ;  or  if  you  courteously  let  them  know  as 
they  come  in  that  time  is  very  precious  with  you,  they  cannot 
deem  you  uncivil,  and  will  be  brief,  unless  they  are  unusually 
pachydermatous.  If  you  are  greatly  annoyed  by  such  visitors, 
have  a  placard  posted  with  "  Please  be  brief,  as,  being  busy,  I  must 
divide  my  time."  Another  good  plan  is  :  at  the  first  conclusion 
of  a  topic,  or  the  first  movement  of  the  patient  after  the  true 
business  of  his  or  her  visit  is  finished,  courteously  to  rise  from 
your  chair,  as  if  you  anticipated  his  or  her  rising  to  go. 

To  rid  yourself  of  attending  undesirable  would-be  patients 
will  be  one  of  the  most  difficult  dilemmas  that  will  confront 
you.  If  you  are  "  Too  busy  to  attend,^''  or  "  Not  at  home,"  these 
are  probably  the  most  unassailable  of  all  reasons  in  such  cases. 
To  assume  charge  of  a  sick  person  and  neglect  him  afterward 
is  unjustifiable. 

You  have  a  right  absolutely  to  decline  to  take  charge  of  a 
case,  but,  if  you  do  assume  the  duty,  it  constitutes  a  contract  in 
which  you  agree  to  give  proper  attention  and  your  best  skill. 
To  take  charge  and  afterward  neglect  it  is  a  great  wrong.  It 
is  very  much  better  at  once  to  plead  having  too  much  other 
business,  or  any  other  true  reason,  and  not  take  undesirable 
cases  at  all,  than  to  take  them,  involve  yourself,  and  afterward 
relinquish  them,  and  expose  yourself  to  criticism  and  abuse. 

When  you  receive  calls  to  cases  that  from  any  cause  you 
can  not  or  will  not  attend,  you  should  at  once  notify  them  of 
that  fact,  that  they  may  seek  some  other  physician,  so  that  the 
patient  may  be  spared  needless  delay  and  you  the  annoyance 
of  repeated  messages  and  solicitations. 

No  one  can  blame  you  for  not  being  at  home  when  your 
services  may  chance  to  be  needed,  since  you  cannot  be  every- 
where at  once;  but  if  you  are  at  home,  and  quibble  or  refuse 


172  THE    PHYSICIAN    HIMSELF: 

to  respond  to  a  call,  you  will  sometimes  be  severely  criticised, 
especially  if  the  case  should  happen  to  go  wrong  in  consequence 
of  your  not  responding.  It  is  much  easier  for  a  lawyer  to  refuse 
to  take  a  client,  or  for  a  mechanic  to  decline  a  job  or  a  mer- 
chant a  sale,  than  for  a  physician  to  refuse  to  go  to  a  case. 

If  you  have  a  friend  whom  you  would  like  to  see  called  to 
a  case  that  you  decline,  mention  him  to  them  by  name.  You 
can  advise  them  to  send  for  Dr.  A.,  or  B.,  or  C,  or  D.  If  you 
have  anything  against  Dr.  E.,  be  careful  to  avoid  saying,  "Do 
not  send  for  Dr.  E;"  merely  omit  to  mention  him.  Your 
silence  will  be  condemnation  sufficient.  You  are  not  bound 
to  recommend  a  man,  but  you  might  have  some  subsequent 
unpleasantness  were  you  to  practically  denounce  him. 

The  chief  objection  to  recommending  persons  whom  you 
wish  to  cast  off,  to  physicians  whom  you  wish  to  aid,  is  that  they 
are  then  quite  sure  still  to  hanker  for  you,  and  to  involve  you  as 
a  consultant  or  assistant  to  your  j^ro^e^e  if  things  get  serious; 
whereas,  if,  instead  of  recommending  them  to  any  particular 
person,  you  compel  them  to  choose  some  one  for  themselves, 
you  will  get  rid  of  them  permanently. 

You  will  occasionally  encounter  presumptuous  patients,  or 
their  wiseacre  friends  or  relatives, — 

"All  impudence  and  tongue," — 

whose  ignorance  is  shown  by  the  very  fact  that  they  do  not 
know  they  are  ignorant,  who  will,  with  a  double  meaning  in 
every  word,  make  meddling  inquiries,  examine  and  cross-ques- 
tion you,  and  rudely  interject  tlieir  opinions,  or  challenge  you 
to  controversy,  or  seek  and  presume  to  discuss  your  diagnosis 
and  your  remedies  with  you,  thrust  forward  their  own  favorite 
doctors,  or  obtrude  their  prescriptions  of  food  or  medicines,  and 
parley  about  the  merits  of  various  medicines.  Such  people  are 
generally  as  full  of  doubts,  beliefs,  and  theories  as  a  lemon  is 
of  acid, — foreknowing  and  prejudicing  all  that  you  do,  often 
destroying  faith,  and  thwarting  your  every  effort ;  may  be,  draw- 
ing the  curtain  aside  after  your  back  is  turned,  and  exposing  to 


HIS    REPUTATION    AND    SUCCESS.  173 

everybody  things  that  should  rightly  be  regarded  as  your  pro- 
fessional secrets.  If  you  write  a  prescription  for  gonorrhoea,  or 
cough,  or,  indeed,  any  other  ailment,  many  a  presumptuous 
patient  or  his  keen  friend  will  read  it  as  fast  as  you  have  written 
it,  and  proceed  to  comment  or  argue  on  it. 

"I  ain't  afeard  to  argify  the  topic  with  'im." 

You  will  often  be  harassed  and  cross-examined  by  such  self- 
constituted  Solomons,  and  compelled  to  resort  to  various  ex- 
pedients to  satisfy  or  baffle  them,  and  at  the  same  time  avoid 
collision  with  their  whims,  insinuations,  and  prejudices.  In 
fact,  from  this  cause,  the  good  effects  of  mystery,  hope,  expecta- 
tion, and  will-power  are  of  late  almost  entirely  lost  to  regular 
physicians ;  all  special  confidence  being  sapped,  all  that  you  can 
expect  in  many  cases  is  the  gross  physiological  action  of  your 
medicines  on  the  stomach  and  bowels  of  the  patient,  and  preju- 
dice and  fear  actually  do  much  to  thwart  even  that.  Such 
meddling,  ignorant  gossips  will  make  your  duty  difficult,  and 
often  actually  aid  in  making  curable  diseases  fatal. 

When  you  prescribe  a  mixture  of  two  or  more  articles  that 
such  a  patient  is  familiar  with,  take  care  to  make  him  under- 
stand that  to  judge  the  relative  proportions  needed  of  each 
ingredient  is  just  as  important  as  the  ingredients  themselves. 

The  presence  of  self-important  sick-room  critics,  with  jeal- 
ous eyes  and  unbridled  tongues,  will,  if  you  are  at  all  timid, 
often  impair  or  destroy  your  usefulness,  by  either  diverting  your 
mind  from  your  case,  or  lessening  your  concentration  upon  it, 
and  mav  even  lead  to  mistakes  in  diao;nosis  or  treatment.  Con- 
sciousness  of  being  watched  by  hostile  nurse  or  visitor,  who  is 
hoping  to  detect  some  flaw,  or  a  chance  to  make  unfriendly 
criticism,  or  find  fault  merely  to  show  that  he  is  a  zealous  friend 
to  the  sick  person,  will,  in  many  cases,  embarrass  your  demeanor, 
and  to  some  extent  cloud  your  judgment,  and,  of  course,  mar 
your  usefulness.  More  patients  are  visited  to  death  by  neigh- 
bors and  friends  than  die  by  neglect. 

It  is  better  to  leave  your  directions  about  medicine,  food, 


174  THE   PHYSICIAN    HIMSELF: 

etc.,  with  the  nurse,  or  whoever  may  be  in  charge,  than  with 
tlie  patient.  Leave  no  room  for  unpleasant  mistakes  or  queer 
bhmders.  Tell  him  in  a  concise,  clear,  distinct  manner  when 
and  how  every  remedy  is  to  be  used,  and  how  you  expect  it  to 
act,  and  leave  nothing  to  the  discretion  or  guess-work  of  patients 
or  nurses.  "A  few  drops,"  "a  little,"  "a  pinch,"  "a  sip,"  "a 
swallow,"  "  a  gulp,"  "  a  thimbleful,"  "  about  a  mouthful,"  "  a 
handful,"  "  a  cupful,"  "  big  as  a  peach,"  "  the  size  of  a  bean," 
"every  hour  or  two,"  etc.,  can  each  open  the  door  for  big  mis- 
takes. Be  explicit  as  to  whether  the  patient  is  to  be  aroused 
from  sleep  to  take  the  medicine  or  not.  Also,  whether  it  is 
to  be  taken  during  the  night  at  all,  with  or  without  water,  etc. 

Give  all  your  directions  at  one  time  instead  of  in  scattered 
fragments ;  take  care  to  make  them  precise  and  complete,  and 
if  you  have  doubts  whether  they  are  fully  understood,  ask  the 
person  to  whom  you  have  given  them  to  repeat  them  to  you,  or, 
if  highly  important,  write  them  down. 

Study  so  to  control  your  countenance  as  to  prevent  your 
thoughts,  embarrassments,  and  opinions  from  showing  upon  it 
during  anxiety  and  emergencies,  and  be  especially  guarded  in 
your  manner,  so  that  nervous  and  ill  patients  cannot  detect  in 
your  flushing  cheek,  quivering  eyelash,  or  faltering  voice,  un- 
favorable reflections  about  themselves  which  you  wish  to  con- 
ceal ;  for  while  your  eyes  are  fastened  on  them  to  appreciate 
their  condition,  theirs  will  be  riveted  on  you  to  read  their  fate. 

Make  it  a  rule  not  to  prescribe  large  quantities  at  a  time 
in  acute  cases,  as  they  may  change  from  day  to  day,  or  even 
from  hour  to  hour ;  it  is  far  better  to  have  tlie  prescriptions  re- 
peated over  and  over  again  than  to  risk  having  half  a  bottle  set 
aside  untaken.  It  is  always  a  nice  point  in  practice  to  decide 
how  large  a  quantity  of  medicine  to  order  at  a  time.  In  many 
acute  cases  you  may  find  it  wiser  to  order  only  suflicient  medi- 
cine to  last  from  one  visit  to  the  next. 

To  set  aside  unused  medicines  and  order  otliers  in  such  a 
way  as  not  to  impair  confidence  requires  not  a  little  clever  man- 


HIS    KliPUTATION    AND    SUCCESS.  175 

agement.  In  many  cases  where  the  effect  of  a  remedy  is  ex-. 
haiisted  and  it  is  ceasing  to  be  useful,  or  where  any  other  indi- 
cations for  a  change  of  treatment  appear,  it  is  better  not  to  stop 
the  old  abruptly,  as  though  it  were  wrong  or  doing  harm,  but, 

insitead,  to  give  instructions  to  discontinue  it  at o'clock  and 

then  begin  with  the  new. 

Patients  will  rarely  complain  of  the  cost  of  medicines  that 
are  taken,  but  they  will  observe  the  waste  and  criticise  you  when 
you  set  one  half-used  remedy  aside  and  prescribe  another.  A 
good  plan  is  to  order  the  empty  bottle  in  which  one  medicine 
was  gotten  to  be  washed  and  carried  to  get  the  next  in.  A  medi- 
cine that  has  been  discontinued  is  rarely  again  indicated.  If, 
when  you  stop  one  remedy  and  order  another,  there  be  any  pros- 
pect of  its  being  used  again  later  in  the  case,  take  care  to  men- 
tion it,  as  it  will  tend  to  avert  the  otherwise  probable  impression 
tliat  there  has  been  extravagance  or  misjudgment  in  prescribing. 

Be  also  guarded  against  ordering  patients  to  buy  expensive 
instruments,  reclining  chairs,  supporters,  braces,  atomizers,  or 
other  costly  articles,  unless  you  are  very  sure  they  will  answer 
the  purpose  and  will  be  used.  It  is  anything  but  creditable  to 
the  physician  to  have  people  exhibiting  this  or  that  article  that 

cost ,  ordered  by  him,  but  for  one  reason  or  another  never 

used,  and  now  referred  to  as  a  shameful  instance  of  needless 
expense. 

You  will  occasionally  encounter  patients  who  have  been 
kept  in  a  furnace  of  anxiety  and  terror  for  months  or  years  (hell 
on  earth)  through  the  ignorance  of  some  novice  in  the  profession, 
who  has  examined  their  simple  sore,  or  abrasion,  and  mistakenly 
pronounced  them  syphilitic,  or  through  the  deception  of  some 
rapacious  and  shameless  quack,  who,  for  the  sake  of  fleecing,  has 
falsely  announced  the  existence  of  specific  disease,  to  which  their 
folly  has  unfortunately  exposed  them,  and  whose  ravages  and 
horrors  their  fears  have  painted  to  them  in  the  blackest  colors, 
when  in  fact  they  have  really  never  had  any  true  sign  or  symp- 
tom of  that  disease.     It  is  torture  enough  for  those  who  really 


176  THE    PHYSICIAN    HIMSELF  I 

have  constitutional  syphilis  to  go  through  life  filled  with  gnawing 
remorse  for  the  past,  and  consumed  with  horror  for  the  future, 
without  adding  spurious  cases.  When  examination  proves  that 
the  case  before  you  is  not  real  syphilis,  it  is  your  highest  duty 
to  give  such  explanation  and  assurance  as  will  fully  banish  the 
error  from  your  patient's  mind. 

You  will  be  sure  to  produce  unnecessary  alarm  and  distress, 
in  the  minds  of  those  whose  chests  you  examine,  if,  after  going 
through  your  scientific  movements,  or,  with  your  watch  in  one 
hand  and  the  fingers  of  the  other  on  their  pulse,  you  tell  them  of 
"  a  slight  deposit  in  the  apex,"  "  an  abnormal  resonance,"  "  a 
hrait  de  diahle^'*  "  rales,"  "  a  palpitation,"  "disordered  rhythm," 
or  other,  to  them,  ominous  symptom  or  harbinger.  Be  careful, 
therefore,  to  avoid  saying  or  doing  anything  that  will  unneces- 
sarily fix  the  mind  of  a  patient  on  the  character  of  his  breathing, 
the  action  of  his  heart,  etc. 

You  will  occasionally  meet  with  persons  who  were  told 
years  ago  by  Dr.  Longface,  or  Dr.  Ogre,  or  Dr.  Spliynx,  with  a 
face  as  long  as  the  bedstead,  that  their  lungs  were  gone,  and  that 
they  would  not  live  a  year ;  or  that  their  measles  would  turn  to 
consumption,  or  that  they  had  the  seeds  of  this  or  that  affliction 
which  would  destroy  life  within  such  a  time.  Such  unnecessary 
and  unwise  forebodings  cast  not  a  little  discredit  on  the  pro- 
fession, and  justify  severe  censure  on  the  erring  prophets  who 
make  them. 

God  only  knows  how  many  young  women  in  our  land  are 
now  nervous  and  dyspeptic,  with  hollow  eyes,  sunk  in  deep 
anxiety,  tormented  with  apparitions  of  "  womb  complaint," 
which  have  no  existence  except  in  Dr.  Spayemall's  imagina- 
tion or  in  Dr.  Squintum's  opinion ;  young  women  who — had 
not  the  subject  been  suggested  to  their  minds — would  have  lived 
a  life-time  with  scarcely  a  thought  of  such  a  thing  as  a  womb. 

The  chief  reason  why  womb-doctoring  might  tempt  to  dis- 
simulation, and  why  there  are  so  many  spurious  cases  of  womb 
disease,   is  obvious.     When  a  man  is  told  he  has  a  luxated 


HIS    REPUTATION    AND    SUCCESS.  177 

shoulder,  or  a  cataract,  or  hernia,  or  cancer,  he  finds  many 
ways  by  which  to  confirm  or  refute  tlie  physician's  opinion,  and 
lie  can  also  see  what  effect  the  treatment  is  having ;  but  when  a 
miserable,  nervous  woman,  morbid  on  the  mysterious  subject  of 
"  womb  disease,"  goes  to  Dr.  Bugaboo  or  Dr.  Fallopius,  mounts 
his  gynaecological  table  or  chair,  with  its  elevating  mechanism, 
*'  gets  examined,"  and  is  told,  correctly  or  otherwise,  with  a 
solemn  phiz,  and  with  all  the  force  of  a  proclamation,  that  her 
womb  (like  many  noses)  is  "  turned  a  little  to  one  side,"  or  "  is 
down,"  "  ulcerated,"  "  dislocated,"  or  "  affected,"  or  that  she 
has  pyosalpinx,  or  salpingitis,  it  tallies  exactly  with  her  fears ; 
and,  shrinking  from  both  the  expense  and  the  exposure  to  be 
endured  if  she  were  to  consult  another  physician,  she  naturally 
submits  to  the  manipulations,  long  periods  of  treatment,  and 
the  monetary  exactions  of  the  physician  or  the  charlatan  who 
first  made  the  examination, — possibly  recovering  from  morbid 
states  that  never  existed  and  paying  for  cures  never  performed. 

"Small  justice  shown,  and  still  less  pity." 

If  there  be  a  knave  meaner  than  all  others  in  the  sight 
of  God  it  must  be  the  swindler  who,  void  of  moral  sense, 
pretends  to  make  operations  on  parts  of  the  body  the  patient 
cannot  see,  or  makes  useless  ones,  or,  with  cold-hearted  selfish- 
ness, exaggerates  the  nature  of  any  case  and  terrifies  the  suf- 
ferer for  dollars  and  cents. 

"Remember  him,  the  villain,  righteous  heaven  ! 
In  thy  great  day  of  vengeance." 

It  is  also  cruel  to  tell  patients,  without  due  explanation, 
that  their  trouble  arises  from  the  heart,  or  kidneys,  or  liver,  or 
the  lungs ;  or  that  they  have  the  "  liver  complaint,"  or  "  kid- 
ney disease,"  or  that  their  lungs  are  "affected,"  when  there  is 
only  some  slight  or  temporary  affection  of  these  organs.  And  it 
is  still  more  cruel  and  unwise,  and  terrorizing,  to  predict  imme- 
diate or  impending  death,  even  if  you  discover  serious  organic 
disease  of  the  heart  or  the  lungs.     The  duration  of  life  will,  in 


178  THE    PHYSICIAN    HIMSELF: 

many  cases,  depend  on  circumstances  that  you  cannot  always 
foresee, — the  cheerfuhiess  or  depression  of  the  patient,  his  care- 
fulness and  prudence,  the  conservative  powers  of  his  system,  the 
compensative  efforts  of  nature,  etc.  You  know  that  a  man's 
liver,  or  his  lungs,  or  his  heart  may  be  deranged  this  week  and 
well  the  next ;  but  many  people  think  that  if  any  of  these 
organs  are  aifected  in  any  way  it  is  necessarily  permanent,  and 
it  gives  them  long  and  constant  anxiety.  Many  people  are  at 
this  moment  living  in  as  great  anxiety  as  though  a  sword  were 
suspended  over  them  by  a  hair,  because  they  were  told  long  ago 
by  old  Dr.  Vinegar,  or  Prof  Hasty,  or  Dr.  Cowhelp,  or  Dr. 
Shallow  that  this  or  that  organ  was  affected,  without  explana- 
tion being  given  of  the  functional  or  temporary  character  of  the 
derangement.  By  explaining  the  difference  between  temporary 
ailments  and  those  of  a  permanent  character,  or  the  difference 
between  a  functional  and  an  organic  affection,  you  will  avoid 
magnifying  real  diseases  or  creating  imaginary  ones ;  infuse 
new  joy  into  life,  and  insure  many  a  patient  perpetual  sunshine 
in  exchange  for  constant  gloom.  It  is  your  duty,  at  least,  to 
avoid  all  ambiguity  of  language  in  such  cases. 

Contrary  to  the  belief  of  the  laity,  and  of  some  phy- 
sicians, sudden  death  rarely  occurs  in  heart  disease,  except  in 
aortic  obstruction  and  regurgitation. 

In  nervous,  hysterical,  and  impressible  persons  it  is  pos- 
sible to  convert  a  slight  or  even  an  imaginary  complaint  or 
functional  trouble  in  to  a  serious  one  by  fixing  their  attention  on 
the  organ  deranged ;  hence,  in  these  cases,  ignorance  is  bliss, 
and  the  physician  should  divert  the  mind  of  the  patient  as 
much  as  possible  from  the  real  or  supposed  seat  of  disease,  even 
if  he  has  to  avoid  letting  him  know  exactly  what  he  is  being 
treated  for. 

Even  our  instruments  of  precision  can  be  used  in  such  a 
manner  as  to  excite  the  brain,  and  become  objects  of  study,  fear, 
and  dread.  That  excellent  instrument,  the  (try  life)  clinical 
thermometer,  often  tells  from  day  to  day  tlie  unwelcome  trutli 


HIS    REPUTATION   AND    SUCCESS.  179 

tliat  fever  continues,  till  it  seems  to  the  patient  and  those 
around  that  you  do  little  else  than  measure  how  long  he  has  to 
live,  and  they  almost  wish  it  had  never  been  invented.  Try, 
therefore,  so  to  use  it  as  to  prevent,  if  possible,  such  ill  results. 

Many  now  rush  to  the  vaginal  speculum  on  the  slightest 
pretext.  Never  make  an  examination  with  it  unless  a  correct 
diagnosis  imperatively  demands. 

Take  especial  care  not  to  allow  patients'  attention  to  be- 
come unduly  fixed  on  their  urine.  Some  persons  have  a  morbid 
tendency  to  watch  this  excretion,  and  only  need  a  discouraging 
word  from  the  physician  to  make  them  as  anxious  about  their 
kidneys — with  apprehensions  of  Bright's  disease,  diabetes, 
gravel,  etc.,  arising  before  their  distempered  vision — as  are 
some  women  about  their  wombs. 

You  will  also  have  patients  lacking  in  sound  common 
sense — the  salt  of  wisdom — (generally  soft-bearded  youths  who 
have  not  yet  cut  their  last  molar  teeth),  who  come  tormented 
with  evil  forebodings  over  alleged  conditions  that  are  either 
imaginary  or  perfectly  natural :  some  because  they  have  discov- 
ered that  their  left  testicle  hangs  lower  than  the  right,  or 
because  their  scrotum  remains  contracted  or  relaxed ; — 

"  How  green  you  are,  and  fresh,  in  this  old  world  ;  " — 

others  terribly  alarmed  because  they  have,  in  examining  them- 
selves, discovered  the  little  odoriferous  glands  on  the  posterior 
part  of  the  glans  penis,  and  imagine  them  to  be  chancres  or 
cancers ;  others  because  the  fear  of  disease,  or  of  blackmail, 
or  of  a  charge  of  bastardy,  or  self-accusation,  or  a  reluctance  to 
sin,  or  disgust  for  the  (cow)  female  has  thwarted  their  attempts 
to  copulate  with  loose  women  and  made  them  imagine  them- 
selves impotent.  You  will  also  occasionally  be  asked  for 
advice  by  those  about  to  marry,  and  by  others  newly  married; 
and  also  by  old  sinners,  who  have  burned  the  sexual  candle  too 
fast  in  youth  and  lived  too  fast  in  general,  who  find  their  pas- 
sions or  powers  of  flesh  gone ;  and  others  who  are  almost  crazy 
on  account  of  this  or  that  affliction,  defect,  or  fear.     In  all  such 


180  "  THE    PHYSICIAN    HIMSELF: 

cases  bear  distinctly  in  mind  that  your  opinions  and  advice  are 
your  capital,  and  do  not  fail  to  charge  \onv  fall  fee,  even  though 
you  write  no  prescription.  With  such  patients  the  charge  is 
for  banishing  fears  and  anxieties  and  giving  valuable  information 
and  satisfaction.  No  one  has  a  right  to  tax  your  time  and  talent 
in  any  way  without  proper  remuneration. 

Be  careful  to  warn  all  such  people  against  the  curse  of 
falling  into  the  hands  of  "  Lost-manhood  Quacks,"  Pseudo-scien- 
tific Anatomical  Museum  Impostors,  with  their  terrifying  plates 
and  examples  of  venereal  diseases,  and  other  "  friends  of  erring 
youth,"  who  circulate  pamphlets  on  the  evils  of  spermatorrhoea, 
masturbation,  etc.,  and  do  not  fail  to  tell  them  of  the  mischief 
■such  skulking  impostors  inflict  on*  their  victim's  health,  and  also 
of  their  merciless,  never-ceasing  voracity  for  money.  A  whole 
book  could  be  filled  in  telling  the  various  ways  in  which  these 
human  foxes  wring  money  from  their  victims  as  you  would 
water  from  a  sponge. 

"  Oh  !  for  a  whip  in  every  honest  hand. 
To  lash  such  rascals  naked  through  the  land." 

It  is  doubtful  whether  the  various  medical  guide-books  for 
the  public — Dr.  Quackem  Wiseacre's  "  Family  Medical  Guide," 
Professor  Scolasticus  Lollypop's  "  Every  One  His  Own  Phy- 
sician," and  a  host  of  others — ever  do  any  one  much  good.  It  is 
certain,  however,  that  people  cannot  understand  them  as  they 
are  intended  to  be  understood,  and  that  they  do  a  great  deal  of 
harm,  by  filling  men's  minds  with  imaginary  wisdom,  and  em- 
boldening them  to  try  their  hands  at  doctoring  cases  that  requu'e 
a  physician  until  either  much  suffering  or  permanent  injury  has 
been  entailed,  or  possibly  life  itself  sacrificed. 

Are  not  such  attempts  to  teach  the  laity  how  to  treat  dis- 
eases like  trying  to  teach  one  how  to  read  who  does  not  know 
how  to  spell  1 

The  eight  or  ten  large  papillae  seen  upon  the  base  of  every 
one's  tongue  often  occasion  much  anxiety,  on  being  discovered 
by  overanxious  laymen,  while  looking  into  their  throats  for  indi- 


HIS   REPUTATION    AND    SUCCESS.  181 

cations  of  syphilis,  diphtheria,  or  ulcerations,  and  great  reUef 
is  afforded  when  told  that  these  are  natural. 

You  will  often  be  consulted  by  true  syphilitics,  who  wish 
to  know  what  would  be  the  result  of  their  marriage.  To  such 
never  promise  certain  immunity  against  future  outbreaks;  and 
do  not  sanction  marriage,  unless  three  years  at  least  have  elapsed 
since  they  contracted  syphilis,  and  at  least  two  years  since  they 
had  any  indications  of  the  disease.  Even  then  they  should 
marry  only  under  hygienic  and  therapeutic  restrictions. 

When  a  patient,  alarmed  about  his  health,  consults  you,  if 
you  wish  your  opinion  fully  to  satisfy  him,  he  earnest^  and  let 
personal  intentness  to  his  case  overshadow  all  that  you  say  or 
do  ;  take  especial  care  not  to  divert  his  conversation  from  himself 
to  extraneous  subjects.  If  it  be  at  your  office,  do  not  digress 
by  showing  him  your  paintings,  or  the  toy  steam-boat  you  are 
making,  or  by  telling  the  latest  bits  of  news  or  gossip,  or  the 
history  of  the  good  cigar  or  fine  pipe  you  are  smoking,  or 
of  the  newspaper  or  novel  you  are  reading,  or  of  the  cane  you 
are  twirling.  If  he  divert  the  conversation  from  his  case,  bring 
him  back  to  it  at  the  first  opportunity,  and  know  nothing  but 
your  professional  duty. 

Never,  under  any  circumstances,  recommend  sexual  inter- 
course as  a  remedy  for  self-pollution,  nocturnal  emissions,  hyper- 
activity of  the  sexual  system,  spermatorrhoea,  hypochondriasis, 
disordered  emotions,  acne,  unruly  sexual  excitement,  priapism, 
prostatitis,  or  anything  else.  If  those  who  are  subject  to  these 
affections  choose  to  run  the  risk  of  syphilis,  or  gonorrhoea,  or 
bastardy,  or  exposure ;  or  to  commit  rape,  adultery,  or  self- 
])ollution,  or  marry  merely  as  a  remedial  agent  for  masturba- 
tion or  nocturnal  emissions,  let  it  be  on  their  own  responsibility, 
not  on  yours.  Perfect  chastity  is  not  only  entirely  compatible 
with  good  health  ;  but  I  know  of  no  disease,  either  of  body  or 
mind,  in  which  sexual  intercourse  is  essential  as  a  remedy  or 
palliative,  and  I  do  know  that  it  is  far  better  for  all,  male  and 
female,  to  grow  up  pure  in  mind  and  body. 


182  THE    PHYSICIAN    HIMSELF  : 

Bear  in  mind  that  night  emissions  recnirring  occasionally  in 
young  men  partake  of  the  nature  of  an  overflow  from  seminal 
plethora,  and  are  perfectly  compatible  with  sound  health.  Young 
fellows,  half-crazed  with  dread  and  remorse,  will  often  consult 
you  about  these  emissions,  and  you  will  find  that  almost  every 
one  attributes  them  to  self-pollution  in  boyhood.  The  results 
of  masturbation,  however,  are,  as  a  rule,  much  less  baneful  and 
destructive  than  commonly  supposed ;  when  the  nasty,  unnatural 
habit  is  stopped,  its  results  are,  as  a  rule,  quickly  recovered  from. 

Consumptive  females  whose  blood-making  power  is  less- 
ened by  their  disease  naturally  cease  to  menstruate.  They  then 
attribute  their  decline  in  healtli  to  the  absence  of  the  menses, 
whereas,  the  cessation  is  really  due  to  the  decline  and  consequent 
loss  of  blood-making  power.  When  such  patients  appeal  to 
you  to  restore  their  menses,  you  should  explain  why  they  have 
ceased,  and  why  they  will  not  return  until  their  health  and  their 
blood-making  power  improve. 

Consumptive  persons  sometimes  have  hectic  fever  so  regu- 
larly at  a  certain  hour,  day  after  day,  that  they  and  their  friends 
are  persuaded  that  their  sickness  is  malarial  in  cliaracter,  and  if 
you  are  not  on  the  alert  they  may  mislead  you  in  your  diagnosis, 
and  into  giving  an  erroneous  opinion  to  that  eflect.  If  tlie 
administration  of  quinia  has  no  specific  effect  on  the  periodic 
daily  fever,  in  a  weakly  or  health-broken  person,  you  may  suspect 
that  it  is  hectic  rather  than  malarial  fever. 

The  popular  belief  that  one  is  hooked  for  consumption 
because  a  parent,  or  brother,  or  sister  died  of  it,  is  true  only  in 
a  limited  sense.  If  the  relative's  disease  were  part  of  his  law  of 
development  and  were  in  his  charter  of  life,  so  to  speak,  develop- 
ing just  when  the  rose-bud  becomes  the  full-blown  flower,  it 
should  indeed  excite  serious  fears  in  every  one  who  has  the  same 
charter,  the  same  constitutional  tendency.  But  if  his  disease 
began  after  his  physical  development  was  fully  completed,  or  if 
it  were  brought  on  by  an  accidental  cause,  tlie  law  of  heredity 
does  not  apply.     One  whose  father,  mother,  sister,  or  brother 


HIS    REPUTATION    AND    SUCCESS.  183 

died  from  phthisis,  the  sequence  of  bad  hygiene,  pneumonia, 
etc.,  is  not  thereby  necessarily  compromised,  inasmuch  as  that 
variety  is  not  hereditary  unless  his  father  had  it  at  the  time  when 
he  begot  him,  or  his  mother  during  her  pregnancy  or  time  of 
nursing.  Only  about  thirty-six  per  cent,  of  those  who  die  of 
consumption  inherit  it. 

One  person  in  every  seven  firmly  believes  that  he  has 
either  heart  disease  or  consumption,  while  those  really  affected 
with  either  are  rarely  willing  to  admit  it,  the  consumptive  gen- 
erally to  the  last  calling  it  a  bad  cold.  You  will  find  that  tlie 
management  of  those  who  are  actually  suffering  with  one  or  the 
other  is  one  of  the  most  delicate  questions  in  practice.  When 
your  opinion  is  invoked  in  these  cases,  do  not  examine  or  ques- 
tion them  at  all,  unless  you  have  time  to  do  so  thoroughly,  for 
your  primary  opinion  and  treatment  may  influence  their  entire 
future  course,  and  if  anything  be  overlooked  at  the  onset  you 
may  unwittingly  induce  a  neglect  of  essential  remedies  until  the 
patient  is  beyond  their  reach. 

No  wonder  the  mind  dreads  the  great  white  plague,  con- 
sumption, with  its  pale,  ghastly  white  face,  flushed  yet  pallid 
cheek,  brilliant  yet  dimmed  eye,  husky  cough,  rattling  lung 
and  unsteady  hand ;  for  it  is  humanity's  great  destroyer.  Many, 
once  gay  and  happy,  are  to-day  sunk  into  deep  distress,  because 
doomed  by  it  to  a  certain  and  lingering  death.  It  loves  to 
scourge  the  young,  the  beautiful,  the  gentle,  and  the  gifted, — 

"Those  made  of  Heaven's  finest  clay," — 

and  this  portion  of  every  community  is  selected  for  its  most  in- 
tractable and  rapid  forms. 

Valetudinarians,  dreading  every  change  of  weather  and 
every  variation  of  temperature,  almost  invariably  dress  too 
warmly  and  heavily,  and,  in  their  anxiety  to  protect  their  bodies 
from  cold,  wear  so  much  clothing  that  they  shut  all  the  air,  sun- 
light, electric,  and  other  health-giving  influences  from  their 
bodies,  overheat  their  skin,  and  keep  it  constantly  relaxed,  and, 
of  course,  reduce  or  destroy  their  natural  resisting  power,  so  tliat 


184  THE    PHYSICIAN    HIMSELF 

when  the  winds  of  heaven,  or  the  cold  air,  or  a  draught,  or 
even  the  gentle  dews  of  night  fall  upon  them,  the  result  is  like 
jumping  from  the  climate  of  Cuba  mto  that  of  Canada.  No 
one,  sick  or  well,  should  ever  wear  more  clothes  than  are  suf- 
ficient to  keep  him  comfortable.  Every  ounce  beyond  that  is 
unnecessary  and  enervating,  and  increases  the  cold-catching 
tendency. 

People  of  the  opposite  extreme,  knowing  that  cool  bed- 
rooms are  healthy  for  hale  and  hearty  persons,  often  carry  chil- 
dren, subject  to  catarrhs  and  croup,  and  other  invalids,  from  the 
warm  rooms  in  which  they  have  passed  the  day  to  cold  sleeping- 
rooms,  instead  of  giving  them  uniform  warm  air,  day  and 
night,  till  recovery  takes  place.  It  would  even  be  less  hurtful 
to  reverse  it,  and  keep  them  in  a  cold  room  while  awake  and  in 
a  warm  one  during  sleep,  because  there  is  more  nervous  energy, 
and  a  person  has  greater  resisting  power  while  awake  than  dur- 
ing sleep,  which  makes  the  system  more  able  to  withstand  cold. 
For  instance,  the  butcher  can  attend  at  his  exposed,  fireless 
stall  the  coldest  winter  weather  till  midnight,  and  not  even 
sneeze ;  but,  were  he  to  lie  down  on  his  stall  and  sleep  during  a 
similar  period,  he  would  probably  get  chilled  and  contract  catar- 
rhal pneumonia  or  rheumatism.  It  devolves  on  you  to  point 
out  these  and  kindred  dangers  to  patients  who  are  risking  them. 

Register-heat,  on  account  of  its  parching  dryness,  is  bad  for 
both  sleeping-  and  sitting-  rooms.  You  will  often  smile  at  seeing 
a  small  pan  or  cup  of  water  simmering  on  a  stove,  or  under  a 
register  that  is  pouring  out  a  volume  of  overdry,  impure  air, 
while  the  inmates  are  blissfully  believing  that  it  is  tempering  and 
rendering  pure  and  moist  all  the  air  passing  over  it.  A  ^ery 
large  wet  towel  or  folded  sheet  hung  over  the  opening,  with  its 
lower  end  in  a  basin  of  water,  is  much  more  effective. 

Many  newborn  children  are  unwittingly  exposed  to  the 
bad  effects  of  cold  from  lack  of  knowledge  on  the  part  of  those 
in  charge.  The  popular  belief  is,  that  if  the  nurse  puts  plenty  of 
clpthes  on  a  shivering  babe  she  has  done  all  that  is  needed ; 


HIS    REPUTATION    AND    SUCCESS.  185 

whereas,  if  the  little  babe,  whose  heat-generating  power  is 
naturally  very  feeble,  after  a  prolonged  oiling,  and  soaping,  and 
washing,  and  turning,  and  wiping,  and  powdering,  and  band- 
aging, be  put  into  clothes  in  a  cold  condition,  without  further 
attention,  hours  or  days  may  elapse  before  its  feeble  heat-making 
power  can  bring  on  a  reaction,  and  warm  its  blue  feet  and  cold 
nose.  Ice  is  put  into  woollen  cloths  or  blankets  to  prevent  it 
from  melting;  cold  bread  wrapped  in  a  blanket  would  never 
warm  itself,  but  if  warmed  and  then  wrapped  in  a  blanket  it 
would  retain  the  heat  for  some  time.  Take  care,  therefore,  that 
the  newborn  babe  is  kept  warm.  As  soon  as  it  is  dressed  it 
should  be  nestled  against  its  mother's  bosom  till  warm  ;  if  this 
does  not  suffice,  it  should  be  kept  near  the  fire  till  the  requisite 
warmth  has  been  imparted. 

Remember  that  the  act  of  nursing  not  only  supplies  the 
babe  with  nourishment,  but  also  communicates  a  new  supply  of 
heat  from  the  mother,  and  possibly  electricity,  or  some  other 
occult  but  useful  influence ;  at  any  rate,  it  can  do  no  harm  to 
have  all  hand-fed  babes  nestled  to  some  one's  warm,  bare  breast 
at  intervals  of  a  few  hours,  in  exact  imitation  of  those  that 
suckle. 

The  ancient  custom  of  clothing  infants  in  flannel,  with 
woollen  socks,  during  hot  weather,  creates  discomfort  and  dis- 
poses to  infantile  sickness.  Its  harmfulness  should,  therefore,  be 
made  known  to  those  whom  you  find  following  it. 

There  is  a  wide-spread  popular  error,  participated  in  to  some 
extent  even  by  physicians,  regarding  the  real  object  of  lancing 
children's  gums.  When  a  physician  lances  or  rubs  a  child's 
swollen  gums,  he  does  so  not  solely  to  let  the  tooth  through, 
nor  does  he  expect  it  instantly  to  pop  through  the  opening,  but 
his  chief  object  is  to  sever  the  innumerable  small  nerves  that 
ramify  through  the  gum,  and  thus  relieve  the  tension,  pain, 
irritation,  danger  of  convulsions,  etc.  No  one  should  incise  or 
rub  through  a  child's  gums,  except  when  these  evils  are  present, 
for  so   much    prejudice    exists  on  this  subject  among   certain 


186  THE    PHYSICIAN    HIMSELF  I 

people,  that  if  you  lance  their  sick  child's  gums  and  in  despite 
of  it  he  dies,  you  will  incur  their  malediction  for  doing  it. 

There  is  much  less  popular  opposition  to  rubbing  children's 
teeth  through  with  a  thimble,  spoon-handle,  or  any  other  suit- 
able article,  than  there  is  to  lancing  them  ;  and  the  contused 
wound  made  by  rubbing  is  less  apt  to  reunite  than  a  clean 
incision. 

"  Doctor,  my  child  gets  the  phlegm  up,  but  instead  of  spit- 
ting it  out  he  swallows  it  again,"  is  a  stereotyped  expression. 
If  he  does,  it  makes  but  little  difference,  inasmuch  as  he  swal- 
lows it,  not  back  into  the  windpipe  or  lungs,  but  into  the 
stomach,  where  it  becomes  unimportant.  It  is,  of  course,  un- 
natural for  a  child  to  spit  before  he  is  three  years  of  age. 

It  is  a  popular  belief  that  crossness  in  sick  children  is  a 
favorable  sign,  and  there  often  appears  to  be  a  great  deal  of 
truth  in  it,  since  it  requires  considerable  strength  and  energy  to 
exhibit  crossness.  The  re-appearance  of  tears  in  the  child's  eyes 
when  crying  is  also  a  favorable  sign. 

Never  pooh  !  pooh  !  or  make  fun  of  mothers  because  they 
believe  their  children  have  worms,  for  in  some  instances  they 
are  correct  in  their  opinions,  and  if  you  scout  the  idea  and  fail 
to  give  a  trial  remedy,  you  may  be  chagrined  to  learn  that  after 
leaving  you  they  went  to  some  drug-store,  purchased  a  quack 
vermifuge,  which,  sure  enough,  brought  away  worms,  and  are 
exultingly  telling  it  as  proof  that  you  were  wrong  and  they  were 
right.  Such  cases  are  a  cause  for  blushing,  and  do  one's  repu- 
tation no  good.  It  is  better,  when  worms  are  suspected,  to 
respect  their  opinions  and  desires,  and  give  some  harmless  ver- 
mifuge, even  though  it  do  no  other  good  than  to  test  the  fact 
and  satisfy  the  mother.  Mothers  are  often  acute  observers,  even 
though  they  are  not  good  prescribers. 

It  is  better  in  all  cases  to  allow  a  certain  degree  of  weight 
to  the  opinions  of  the  patient  and  his  attendants,  especially 
those  who  sit  up  with  him  at  night ;  not  that  you  should  sur- 
render your  judgment  to  their  exaggerated  apprehensions  or 


HIS    REPUTATION    AND    SUCCESS.  187 

palpable  errors,  but,  at  least,  listen  calmly  to  what  they  say,  and 
take  in  consideration  their  opinion  in  making  up  your  own. 

"The  nurse's  tongue  is  privileged  to  talk." 

They  see  him  the  whole  twenty-four  hours,  while  you  may  see 
him  but  five  or  ten  minutes  a  day.  The  apparently  causeless 
fears  and  predictions  of  nurses  and  friends  are  sometimes  sur- 
prisingly confirmed,  and  the  self-sufficient  physician's  prophecies 
correspondingly  unrealized. 

Many  persons  think  it  is  of  no  use  to  call  a  physician  to 
sick  infants,  because  they  are  unable  to  make  any  verbal  com- 
munication, or  to  place  their  hands  on  the  seat  of  their  diseases 
to  assist  him  in  making  a  diagnosis.  This  opinion  is  erroneous, 
for  the  diseases  of  infants  are  usually  simple  in  character,  and 
their  symptoms,  being  neither  disguised,  concealed,  nor  exag- 
gerated, can  be  read  and  correctly  treated  by  any  wise  physician. 

Condemn  the  keeping  of  commodes  in  bedrooms,  as  they 
are  a  dangerous  source  of  diphtheria,  scarlatina,  typhoid  fever, 
and  other  filth  diseases.  Also,  direct  that  the  alvine  discharges 
in  all  contagious  diseases  and  the  sputa  of  consumptives  shall 
be  either  disinfected  or  destroyed. 

Every  worthy  housewife  courts  the  reputation  of  keeping 
her  house  clean,  and  one  of  the  proofs  of  her  skill  is  the  absence 
from  the  premises  of  bed-bugs,  fine-tooth-comb  insects,  roaches, 
and  other  vermin.  Should  you  ever  notice  such  things  about 
a  respectable  patient's  body,  clothing,  or  bedroom,  affect  not  to 
see  them,  for  nothing  is  more  deeply  mortifying  than  to  have 
anything  of  the  kind  noticed  and  pointed  out  by  the  family 
physician.  Also,  be  oblivious  to  all  mortifying  accidents,  im- 
modest mistakes,  and  accidental  exposures  that  may  occur  in 
the  sick-chamber. 

"  Doctors  must  often  shut  their  eyes  and  close  their  ears." 

The  terms  scarlatina  and  scarlet  rash  are  now  in  everybody's 
mouth,  and  are  spoken  of  by  the  laity  as  harmless  affections, 
under  the    belief  that  the  word  "  scarlatina  "  means  a  slisht 


188  THE    PHYSICIAN    HIMSELF: 

affection,  bearing  about  the  same  relation  to  scarlet  fever  that 
varioloid  bears  to  variola.  There  is  no  such  disease  as  scarlet 
rash,  and  the  cases  to  which  these  terms  are  applied  are  usually 
either  scarlet  fever  or  rotheln  (German  measles),  and,  unless 
people  are  made  to  understand  this,  neglect  of  the  necessary 
precautions  and  great  damage  may  result. 

Bringing  out  the  eruption  is  one  of  nature's  processes  in 
measles,  scarlatina,  small-pox,  etc.,  but  there  is  no  doubt  that 
the  large  quantities  of  saffron-tea,  ginger-toddy,  hot  lemonade, 
home-made  wines,  etc.,  used  by  grannies  to  bring  them  out,  do 
more  harm  than  good,  by  disordering  the  stomach,  inflaming 
the  eruption,  etc.  This  "bringing  out  the  eruption,"  when 
uncomplicated,  had  better  be  left  somewhat  to  nature ;  when 
it  is  complicated,  something  more  reliable  than  teas  is  indicated. 

There  is  also  a  popular  belief  that  all  skin  diseases  result 
from  humors  in  the  blood  that  must  be  driven  out,  or,  if  already 
out,  kept  out,  until  killed  by  blood  medicine,  much  the  same  as 
one  would  drive  rats  from  tlieir  haunts  and  keep  them  out  until 
annihilated.  No  patient  will  object  to  your  driving  his  humor 
out,  or  killing  it,  but  if  he  thinks  you  have  simply  driven  it  in, 
woe  be  to  you  should  he  subsequently  have  any  severe  or  fatal 
sickness.  In  such  cases  it  is  well  to  give  an  internal  remedy, 
whether  local  treatment  is  used  or  not.  In  some  cases,  where 
great  fear  or  strong  prejudice  exhibits  itself,  it  is  even  better  to 
commence  the  internal  treatment  some  days  before  beginning 
the  local. 

There  is  likewise  a  popular  expectation  of  evil  and  a  like 
readiness  to  blame  the  physician  if  any  new  symptom  appear 
after  he  suddenly  arrests  or  cures  periodical  bleedings,  diarrhoeas, 
foot-sweat,  or  chronic  discharges  of  any  kind. 

Many  persons  suppose  boils  and  various  eruptions  to  be 
healthy.  Not  so ;  but,  even  if  they  were,  most  people  will 
agree  that  some  other  mode  of  health  is  decidedly  preferable. 
The  belief  is  probably  foimded  on  the  fact  that  during  conva- 
lescence after  certain  serious  diseases  a  crop  of  boils  often  appears^ 


HIS    REPUTATION    AND    SUCCESS.  189 

seemingly  from  a  revival  of  the  energies,  or  vital  forces  of  the 
system,  from  the  depressing  influence  of  the  disease.  The  fact 
of  their  appearance  being  coincident  with  reorganization  and 
returning  health  probably  accounts  for  the  belief  that  boils  and 
health  naturally  go  together. 

The  high  color  of  the  urine  occasioned  by  activity  of  the 
skin  in  patients  whose  sickness  compels  them  to  lie  in  warm 
beds  or  to  keep  in  hot  rooms,  also  seen  in  well  people  who  per- 
spire freely  during  warm  weather,  frequently  creates  alarm,  and 
induces  groundless  fear  that  they  have  kidney  disease.  Explain 
to  them  how  the  functions  of  the  skin  and  kidneys  are  in  rela- 
tion to  each  other,  and  that  it  makes  but  little  difference  whether 
the  urine  is  scanty  or  abundant  if  it  contain  all  the  natural 
excreta  and  be  simply  deficient  in  water. 

When  a  coin  or  other  small  foreign  body  is  accidentally 
swallowed,  some  old  lady  is  almost  sure  to  recommend  a  dose 
of  castor-oil  or  other  purgative,  thus  liquefying  the  contents  of 
the  bowels  and  necessitating  the  passage  of  the  extraneous  body 
the  entire  length  of  the  alimentary  canal  alone,  instead  of  allow- 
ing the  fsecal  matter  to  remain  as  a  mass  to  inclose  it  and 
prevent  its  corners  and  sharp  points  or  edges  from  doing  harm. 
When  such  an  article  is  swallowed,  do  not  interfere  with  the 
eff'orts  of  nature  unless  you  feel  sure  she  cannot  expel  it  un- 
aided. 

When  a  person  faints,  those  around  run  to  assist  him,  and 
in  those  agitating  moments  instinctively  raise  his  head,  instead 
of  lowering  it  as  they  should  do,  thus  prolonging  the  syncope 
and  endangering  life. 

In  all  cases  where  great  debility  and  pallor  are  present,  be 
careful  to  instruct  the  attendants  to  keep  the  patient's  head  low, 
and  to  prevent  him  from  rising  suddenly  for  any  purpose,  and 
from  sitting  up  too  long,  or  unwatched,  for  fear  of  fatal  syncope. 

"  If  the  dog  that  bites  a  person  goes  mad,  the  one  bitten 
will  also,"  has  caused  many  a  valuable  dog  to  be  killed.  The 
truth  is,  if  the  dog's  mouth  or  teeth  contain  hydrophobic  'sirus 


190  THE   PHYSICIAN    HIMSELF  I 

at  the  time  of  biting  the  person  there  is  great  risk  of  its  being 
communicated  ;  otherwise,  there  is  no  risk.  If  the  dog  be  killed 
under  the  mere  suspicion  of  having  hydrophobia,  all  inquiries  as 
to  its  madness  are  cut  short,  the  disproof  of  the  disease  is  ren- 
dered impossible,  and  the  person  bitten  and  his  friends  are  left 
to  all  the  terrors  of  uncertainty. 

A  hydrophobic  dog  is  said  never  to  live  longer  than  ten  days 
after  it  becomes  so ;  therefore,  if  a  dog  bite  a  person,  it  should 
by  all  means  be  allowed  to  live  beyond  this  period  to  ascertain 
beyond  doubt  whether  it  has  hydrophobia,  or  is  harmless  ("?). 

Foolish  persons  will  occasionally  tell  you,  in  a  boastful 
manner,  that  they  have  no  fear  of  contagious  diseases,  and  will 
sliow^  either  by  word  or  manner  that  they  entertain  the  belief 
that  contagious  diseases  attack  those  who  dread  them  and  spare 
those  who  do  not.  It  is  well  to  teach  such  people  that  the  laws 
of  small-pox,  syphilis,  gonorrhoea,  hydrophobia,  typhus  fever, 
and  such  affections,  are  very  different  from  what  they  imagine  ; 
that  fear  cannot  communicate  them  to  timorous  persons — man, 
woman,  or  child — who  are  not  exposed  to  their  influence,  and 
that  mere  courage  or  absence  of  fear  will  not,  can  not,  protect 
nurses  or  friends,  old  people  or  babes ;  nor  braggarts,  nor  even 
persons  who  are  unaware  of  their  presence,  if  exposed  to  them. 

You  will  often  be  asked  what  physicians  carry  or  what 
they  use  to  protect  themselves  against  the  epidemics  and  con- 
tagious diseases  which  they  face.  So  it  always  should  be,  but  so 
it  sometimes  is  not,  for  we  do  not  always  escape ;  yet  a  fearless 
heart,  a  cheerful  mind,  and  love  of  duty  often  do  seem  at  such 
times  to  unite  with  hygienic  precautions  to  protect  us  in  our 
battles,  while  the  cowardly  fellow  who  flees  from  the  danger 
w^ould  probably  die  if  he  were  to  stay. 

"Epidemics  kill  hundreds,  fear  kills  thousands." 

There  exists  a  popular  prejudice  against  damp  houses,  leaky 
roofs,  night  air,  dews,  etc.,  which  is  probably  carried  entirely  too 
far.  Dampness  is,  of  course,  inimical  to  health  when  mold, 
absence  of  fresh  air  and   sunliglit,  filtli,  noxious  gases,  or  other 


HIS   REPUTATION    AND    SUCCESS.  191 

defective  conditions,  or  disease-producing  elements  are  added  to 
it ;  but  neither  life  on  board  of  vessels,  nor  the  presence  of 
excessive  dampness,  as  in  rainy  weather,  is  in  itself  unhealthful. 
Dark  houses  and  basement  rooms,  where  the  natural  light  does 
not  reach,  are,  of  course,  unhealthy,  and  may  breed  microbes. 

The  low-spirited  and  the  morbid  will  often  refer  to  the 
fullness  or  emptiness  of  the  veins  on  the  back  of  their  hands, 
and  count  the  wrinkles,  as  proof  that  their  blood  is  drying  up,  or 
that  they  need  bleeding,  or  that  they  are  consumptive.  Explain 
to  them  the  folly  of  such  conclusions. 

When  liniments  are  applied  to  the  extremities  for  swell- 
ings, pains,  etc.,  the  popular  notion  is,  that  to  rub  outward^ 
toward  the  fingers  and  toes,  is  the  proper  and  only  way  to  carry 
off  the  disease,  while  physiology  tells  us  to  aid  the  impeded 
circulation  by  rubbing  toward  the  heart, — a  fact  that  it  seems 
impossible  to  make  people  appreciate. 

As  purgatives  after  confinement,  many  physicians  order 
simples :  castor-oil,  rhubarb,  seidlitz-powders,  etc.,  instead  of 
writing  regular  prescriptions ;  it  will  be  wise  for  you  to  follow 
the  same  rule  and  order  castor-oil  for  a  lying-in  woman,  or  what- 
ever other  simple  laxative  she  or  her  friends  are  accustomed  to 
take,  for  if  you  give  her  a  Latinized  prescription  for  a  purgative, 
and,  as  a  coincidence,  she  has  hyper-purgation,  or  puerperal 
fever,  or  heemorrhages,  or  if  syncope  or  anything  else  follow, 
she  will  be  very  apt  to  believe  that  your  purgative  was  too 
strong,  and  caused  her  sickness  ;  and  if  she  happen  to  die  you 
and  it  will  be  blessed. 

The  admission  or  exclusion  of  persons  who  wish  to  enter 
the  sick-room,  and  allowing  or  forbiddine^  conversation  with  ill 
patients,  or  within  their  hearing,  require  no  little  delicacy  and 
tact.  Exclude  gossips  and  bores  from  the  bedrooms  of  those 
who  are  seriously  ill;  also,  kind  but  thoughtless  idiots,  who  come 
to  tell  the  sick  how  badly  they  look,  or  of  the  death  or  misfor- 
tunes of  neighbors,  or  of  those  who  had  similar  seizures ;  but 
try  to  manage  the  matter  so  as  to  engender  no  personal  enmity. 


192  THE   PHYSICIAN    HIMSELF: 

Endeavor,  also,  to  acquire  expertness  in  answering  anxious 
questions  relative  to  such  cases,  but  never  attempt  to  exclude 
the  parents,  near  relatives,  religious  advisers,  or  other  privileged 
persons  from  the  room  of  any  one  who  is  seriously  ill,  and  never 
interdict  Bibles,  prayers,  and  religious  exercises,  except  for  the 
most  urgent  and  obvious  reasons,  such  as,  when  he  is  highly 
delirious,  or  has  just  taken  an  urgently  needed  sleeping  potion, 
or  where  he  is  determinedly  opposed  to  the  mtroduction  of 
religious  conversation ;  else  you  may  raise  among  them  a  very 
natural  whirlwind  of  indignation  against  you. 

To  interrupt  public  business  and  travel  by  roping  or  barri- 
cading the  streets,  because  somebody  is  sick  in  one  of  the 
houses,  is  seldom  either  necessary  or  justifiable,  as  most  dwell- 
ings have  back  rooms  into  which  the  sick  can  be  taken  out 
of  reach  of  the  noise  of  travel ;  make  it  a  point  to  advise  the 
latter  course  instead  of  the  former.  Where  the  former  is  not 
feasible,  a  good  bed  of  spent  tan  on  the  street  will  completely 
prevent  the  rattle  of  passing  vehicles,  and  show  everybody  that 
a  person  is  sick  whom  noise  will  injure. 

Never  ask  the  age  of  a  patient  more  than  once  during 
attendance  on  his  case.  Take  care,  also,  neither  to  ask  any 
question  twice  at  the  same  visit,  nor  to  do  anything  else  that 
would  indicate  abstraction,  lack  of  memory,  or  incompetence. 

You  will  find  that  patients  will  be  inspired  with  more  faith 
in  a  prescription  if  you  begin  to  write  it  with  an  air  of  decision 
immediately  after  receiving,  to  a  more  or  less  important  question, 
an  answer  which  your  manner  indicates  is  what  you  expected. 

Take  care  to  ask  all  necessary  questions  before  you  com- 
mence to  write  your  prescription,  lest  the  patient  think  that,  in 
forming  your  opinion,  you  liave  not  included  the  additional 
information  or  taken  it  in  consideration  in  writing  the  prescrip- 
tion, or  that  your  treatment  was  determined  on  before  you 
obtained  all  the  facts.  Make  it  a  rule,  also,  to  ask  no  further 
questions  after  prescribing.  It  is  well  to  terminate  a  visit  as 
soon  after  prescribing  as  can  be  properly  done. 


CHAPTER  VII. 

"The  successful  man  is  the  mau  who  knows  human  nature,  as  well 
as  his  profession." 

Every  minute  spent  in  studying  how  to  make  your  reme- 
dies agreeable  will  be  more  advantageous  to  you  than  half  an 
hour  of  any  other  kind  of  study.  Whoever,  in  these  days,  pre- 
scribes nauseous,  repellant  medicine  in  ordinary  cases  injures 
both  himself  and  his  profession,  and  is  deficient  in  one  of  the 
most  simple  and  essential  requirements.  Indeed,  one  of  the 
great  drawbacks  to  young  physicians,  and  one  of  the  chief 
reasons  why  they  fail  to  render  more  practical  assistance  to  their 
older  brethren  in  superseding  pleasant  quackery,  is  that,  hav- 
ing their  attention  riveted  on  their  cases  and  studying  more 
about  getting  them  safely  than  comfortahly  through  their  ail- 
ments, and  being  anxious  to  get  the  specific  physiological  effects 
of  medicines  quickly  and  fully,  they  too  often  give  them  in  crude 
forms,  forgetting  that  the  majority  of  sick  people  are  fastidious, 
and  have  likes  and  dislikes  that  must  be  respected. 

A  great  and  almost  universal  mistake  that  regular  phy- 
sicians make  is  in  supposing  that  when  people  send  for  them 
it  is  for  the  sole  purpose  of  having  medicine  prescribed.  Many 
people,  not  being  judges  as  to  what  cases  need  medicines  and 
what  do  not,  are  much  more  anxious  to  see  one  who  does  know, 
have  a  talk  with  him,  and  get  an  opinion  of  the  nature,  danger, 
probable  course,  and  result  of  their  cases,  and  words  of  assurance 
from  him,  and  some  simple  remedy,  if  necessary,  than  to  be 
drenched  at  every  pore,  or  begin  a  medicine-taking  siege,  or  a 
bombardment  with  gross  drugs. 

Make  special  endeavors  to  retain  every  medicine-hater  who 
chances  to  fall  into  your  hands.  Such  incorrigihles  had  better 
be  under  your  care,  with  rational  supervision  and  small  doses 
of  good  treatment,  than  to  be  paying  some  one  else  for  harmful 
quackery  or  fantastic  nonsense. 

^'  (193) 


194  THE   PHYSICIAN    HIMSELF: 

Keep  ever  in  your  mind  that  mankind  has  both  a  material 
and  a  spiritual  nature,  and  that  different  people  seem  to  be 
made  of  different  and  almost  opposite  qualities;  some  seem  to 
be  two-thirds  spiritual  and  one-third  animal,  others  seem  to  be 
but  one-third  spiritual  and  two-thirds  animal,  between  which 
are  all  intermediate  grades.  If  you  treat  all  these  alike,  you 
will  certainly  fail.  The  mind  belongs  to  the  legitimate  domain 
of  the  physician  as  well  as  the  body,  and  the  moral  and 
mental  management  of  the  sick  is  often  far  more  difficult  than 
the  physical.  A  close,  thoughtful  study  of  mental  forces 
and  of  mental  therapeutics  in  affections  connected  with  the  brain 
and  nervous  system  is  one  of  the  necessities  that  the  regular 
profession  is  still  extremely  deficient  in.  Irregulars  often  give 
a  placebo,  a  mysterious  mystery,  or  a  useless  agent,  which  un- 
questioning faith  and  other  mental  operations  based  on  hopes 
of  recovery  excited  in  the  wondering  patient — potentizes — and 
an  astonishing  cure  (?)  results. 

This  is  probably  the  most  rational  explanation  of  the  fact, 
that  newly  discovered  therapeutical  agents,  as  bromide  of  potas- 
sium, salicylic  acid,  etc.,  make  so  many  more  wonderful  cures 
Avhen  first  heralded  as  remedies  than  they  effect  after  they  have 
taken  a  definite  position  in  the  pharmacopoeia. 

New  or  novel  remedies  often  aid  the  cure  through  mental 
influences.  Many  regular  physicians  prescribe  valuable,  true 
remedies,  but  give  them  just  as  they  would  administer  them  to 
a  horse  or  sheep,  as  if  their  only  duty  consisted  in  telling  the 
sick  what  drugs  to  swallow,  and  seem  to  despise  the  aid  of 
faith,  hope,  and  expectation.  You  must  learn,  in  simple  cases, 
to  depend  more  upon  the  aid  of  hygiene,  diet,  and  mental  in- 
fluences, and  less  on  large  doses  of  disturbing  medicine,  which 
might  allow  room  for  some  patients  to  say  that  you  had  almost 
killed  them. 

Bear  carefully  in  mind  that  Drs.  Diet,  Quiet,  Hope,  and 
Faith  are  four  excellent  assistants  whose  aid  you  should  con- 
stantly invoke.     The  Oil  of  Time  and  Tincture  of  Patience  are 


HIS    REPUTATION    AND    SUCCESS.  195 

also  very  useful  in  some  cases,  but  too  slow  and  inadequate  for 
others,  and  unless  Dr.  Dosomething  takes  the  serious  case  out 
of  Dr.  Donothing's,  Dr.  Tardy's,  or  Dr.  Timorous's  hands,  they 
occasionally  give  one  of  the  confiding  kind  a  wooden  overcoat 
and  put  him  into  the  hands  of  Mr,  Sexton. 

It  is  bad  to  let  nature  take  her  course  when  she  takes  a 
bad  or  a  wrong  one.  You  will  often  see  her  put  a  curable  pa- 
tient in  his  coffin  because  you  were  called  too  late  to  aid  and 
direct  her  course. 

If,  at  the  time,  you  indicate,  to  a  patient  for  whom  you  pre- 
scribe an  unpalatable  medicine,  that  it  will  have  a  bitterish  or  a 
saltish  taste,  or  any  other  unpleasant  quality,  his  mind  will  be 
prepared,  and  it  will  not  seem  so  objectionable  to  him  as  it 
would  were  his  mind  and  palate  taken  by  surprise. 

If  the  directions  on  the  bottle  indicate  what  the  remedy  is 
for, — for  instance,  if  you  have  it  labeled  "  to  be  applied  to  the 
injured  foot  as  directed,"  or  "  for  the  pain  in  the  chest,"  or 
"  for  the  cough," — it  will  tend  to  give  a  certain  class  of  patients 
faith  in  its  being  a  direct  and  special  remedy,  and  cause  their 
minds  to  act  with  it  rather  than  against  it. 

Remember  that  even  a  highly  proper  remedy  may  be 
pushed  too  far,  or  continued  too  long.  Indeed,  cases  sometimes 
reach  a  point  at  which  it  is  better  to  stop  all  medicine  tempo- 
rarily, and  rely  on  hygiene,  diet,  stimulants,  nursing,  etc. 

You  should  keep  yourself  familiar  with  the  ill  effects  that 
may  arise  from  the  use  of  the  various  drugs  which  you  pre- 
scribe, in  order  that  you  may  avoid  producing  them,  or  promptly 
recognize  and  remedy  them  if  they  occur. 

Avoid  as  far  as  possible  the  use  of  medicine  that  must  be 
taken  "  through  a  quill  or  tube,"  or  that  will  burst  the  bottle 
unless  kept  "  in  a  cool  or  dark  place ;  "  on  which  "  no  water 
must  be  taken ;  "  that  must  be  handled  with  caution,  or  that 
must  be  stopped  when  the  eyelids  begin  to  swell,  or  when  the 
muscles  begin  to  jerk,  or  that  the  druggist  must  label  "  Poison ;" 
especially  with  medicine-haters  and  skeptics. 


196  THE    PHYSICIAN    HIMSELF  : 

Some  people  will  not  send  for  you  until  they  are  really  ill, 
for  fear  you  might  put  them  to  bed,  and  thereby  keep  your  car- 
riage at  their  door  ;  or  salivate  them,  or  entail  upon  them  dis- 
comfort instead  of  affording  relief  Others  will  be  afraid  you 
will  give  them  quinine,  or  injure  their  teeth  with  iron  or  calo- 
mel, etc.,  or  that  if  they  once  begin  to  take  medicine  they  will 
not  be  able  to  stop.  Disabuse  the  minds  of  all  such  people  with 
the  assurance  that  their  fears  are  groundless. 

Herb  doctors,  root  doctors,  vegetable-pill  makers,  and  others 
have  created  a  belief  in  the  public  mind  that  remedies  obtained 
from  the  mineral  kingdom — iron,  mercury,  arsenic,  lead,  lime, 
etc. — are  poisonous,  and  should  not  be  taken ;  while  articles 
from  the  vegetable  are  in  consequence  thereof  innocuous  and 
harmless.  The  truth  is, — the  most  powerful  agents — hydro- 
cyanic acid,  belladonna,  elaterium,  croton-oil,  lobeUa,  opium, 
•stramonium,  colchicum,  digitalis,  aconite,  strychnia,  and  a  long- 
list  of  other  very  active  agents — are  "Purely  Vegetable;" 
therefore,  the  announcement,  "Purely  Vegetable,"  is  but  one 
vof  the  numerous  songs  of  these  greedy  sirens. 

"  Iron  injures  the  teeth"  is  a  remark  which  you  will  often 
hear,  and  it  originates  in  the  fact  that  the  old  muriated  tincture 
of  iron  (tinct.  ferri  chloridi),  which  contains  muriatic  acid,  if 
given  without  the  usual  caution,  will  injure  the  teeth,  not  on  ac- 
count of  the  iron,  however,  but  of  the  acid  that  is  associated  with 
it ;  just  as  the  water  that  makes  a  pot  of  boiling  coffee  would 
scald  a  person  all  tlie  same  if  the  coffee  were  not  in  it.  Prepara- 
tions of  iron  containing  no  free  acid  do  not  act  upon  the  teeth. 

Iron  temporarily  blackens  the  tongue  and  the  stools ;  and 
it  is  well  to  tell  persons  this  to  prevent  needless  alarm. 

It  is  believed  by  many  that  quinine  gets  into  the  bones, 
affects  sight  and  hearing,  causes  dropsy,  etc.  So  firmly  do 
some  people  believe  these  things  that  you  will  at  times  have  to 
humor  their  prejudices,  and  change  to  sulphate  of  cinchonia, 
compound  tincture,  or  some  other  preparation  of  bark,  when 
bark  is  indicated. 


HIS   REPUTATION    AND    SUCCESS.  197 

This  prejudice  depends  chiefly  on  the  fact  that,  being  pow- 
erful for  good,  people  naturally  infer  that  it  must  be  very 
strong ;  hence,  also,  powerful  for  evil.  It  is  also  often  due  to 
the  teachings  of  Irregulars,  who  seek  through  it  to  prejudice  the 
public  against  regular  physicians,  while  constantly  but  secretly 
using  it  themselves.  I  have  known  a  conspicuous  Irregular  to 
denounce  quinine  strongly,  and  yet  use  three-grain  ovoid,  gelatin- 
coated  quinine  pills  under  the  name  of  '•'■Panama  Beans  "  for  the 
cure  of  his  patient.  We  know  that  quinine,  when  properly  used,  is 
really  an  almost  harmless  vegetable  product,  which  acts  on  the 
malarial  poison  not  by  great  strength,  but  through  its  antidotal 
influence,  just  as  water,  an  agent  harmless  enough  to  drink  or 
bathe  in,  acts  on  fire. 

One  of  the  most  provocative  and  annoying  hardships  you 
will  have  to  endure  is  the  tendency  of  some  people  who  have 
suffered  protracted  sickness  to  blame  you  or  your  medicine  for 
any  permanent  impairment  or  persistent  lingering  symptoms 
after  illnesses,  instead  of  recognizing  and  acknowledging  the 
fact  that  they  are  the  real  effects  (sequelae)  of  the  disease. 

Reproach  is  often  unjustly  cast  on  physicians  and  on 
medicine  by  people  living  in  malarious  districts,  who  sicken  with 
this  or  that  malarial  affection,  send  for  a  physician,  and  get  well, 
and  might  remain  so,  but,  being  still  surrounded  by  malaria,  they 
again  inhale  it  and  are  again  poisoned.  This  they  erroneously 
call  "  a  return,"  instead  of  a  re-poisoning.  Of  course,  while  the 
laws  of  His  Majesty,  King  Malaria,  remain  as  they  are,  you  can 
no  more  promise  future  immunity  to  convalescents  with  an  agued 
frame  who  remain  in  malarious  districts  than  you  can  promise 
the  anxious  sailor  that  future  winds  will  not  again  create  waves, 
or  the  uneasy  farmer  that  recurring  frosts  will  not  again  nip  his 
exposed  plants. 

Malarial  exhalations  from  the  earth  are  usually  greater 
at  night,  and  greatest  on  the  still,  damp  nights  of  autumn. 
Malarial  affections,  therefore,  are  usually  contracted  in  autumn 
and  at  night,  but  many  people  are  ignorant  of  the  fact  that 


198  THE    PHYSICIAN    HIMSELF: 

they  can  also  rise,  and  be  caught,  during  the  greater  part  of  the 
year ;  they  can  also  be  caught  in  the  day-time,  and  persons 
should  be  put  on  their  guard. 

It  is  proper,  and  your  duty,  to  advise  a  person  to  change  his 
abode  if  necessary  for  his  health,  or  to  relinquish  an  occupation 
if  it  be  injurious  to  him.  Also  to  dissuade  him  from  exciting 
pursuits,  or  from  striving  to  amass  riches  when  his  health  is 
thereby  jeopardized ;  at  the  same  time,  bear  in  mind  that  such 
subjects  are  both  tender  and  delicate  to  deal  with.  Be  on  your 
guard,  therefore. 

Keep  yourself  well  informed  in  regard  to  suitable  clothing, 
physical  exercise,  and  proper  diet ;  also  as  to  the  value  of  pure 
air,  pure  water,  and  pure  soil,  the  comparative  healthfulness  of 
different  regions,  the  presence  or  absence  of  malaria  at  different 
seasons  and  places,  etc. ;  also  in  regard  to  the  various  health  trips 
and  summer  resorts.  Familiarize  yourself  likewise  with  the  con- 
stituents and  peculiarities  of  the  various  mineral  waters,  and  the 
special  uses  of  each ;  with  the  comparative  advantages  of  sea- 
side and  mountain  trips,  and  with  the  classes  of  invalids  to  be 
benefited  by  one  or  the  other  ;  also  with  the  various  baths — 
hot,  cold,  tepid,  Russian,  Turkish,  electric,  vapor,  etc. — and  the 
comparative  advantages  of  the  various  hospitals,  asylums,  sani- 
taria, retreats,  etc. ;  for  such  matters  belong  strictly  to  the 
province  of  medicine,  and  it  is  especially  desirable  that  you 
should  understand  them,  because  you  are  sure  to  be  asked  about 
them,  and  sure  to  be  ashamed  if  you  cannot  answer,  and  the 
refined  and  intelhgent  inquirer  will  feel  disappointment  and 
distrust  of  your  knowledge ;  they  are  subjects  that  concern  the 
better  and  more  desirable  classes  of  patients,  many  of  whom  are 
semi-invalids,  with  whom  you  will  often  have  to  make  hygiene, 
medicinal  waters,  trips,  etc.,  go  hand-in-hand  with  medication; 
also,  remember  that  your  duty  does  not  terminate  with  the  cure 
of  the  malady  which  you  are  called  upon  to  treat,  for  in  almost 
every  case  you  should  lay  down  rules  and  regulations  to  prevent 
a  relapse,  sequelae,  or  future  attacks. 


HIS    REPUTATION    AND    SUCCESS.  199 

You  cannot  be  too  cautious  in  advising  exhausted  patients 
Avith  impaired  appetite  and  weakened  digestion,  or  others  far 
gone  with  obstinate  and  dangerous,  invincible,  or  hopeless  mala- 
dies, to  leave  their  homes  and  undergo  the  fatigue  and  discom- 
forts of  travel  to  the  sea-shore,  mountains,  or  other  distant  places, 
or  to  foreign  countries,  among  strangers,  in  search  of  health, 
unless  there  are  sound  and  good  reasons  for  the  belief  that  the 
change  will  be  beneficial  and  that  improvement  or  restoration 
to  health  will  result.  The  risk  of  breathing  their  last  away 
from  home,  family,  and  kindred,  or  of  a  return  made  worse  by 
the  inevitable  fatigues  and  exposures  of  travel,  is  not  to  be 
assumed  without  full  consideration.  We  sometimes  actually 
hear  it  hinted  that  the  physician  has  sent  the  patient  away  to 
get  rid  of  him,  or  because  he  did  not  know  how  to  treat  him. 

Be  chary  of  sending  people  from  their  homes  to  tlio 
crowded  wards  of  hospitals,  unless  you  feel  assured  tliat  tlie 
management  is  kind,  humane,  and  skillful,  for,  Avhile  hospitals 
and  almshouses  are  an  unspeakable  blessing  to  sick  wan- 
derers, to  the  castaways,  the  forgotten,  and  the  homeless,  they 
are  to  a  less  extent,  if  at  all  so,  to  those  who  have  friends  and 
a  place  to  call  home. 

"Be  it  ever  so  humble,  there  is  no  place  like  home." 

To  remove  a  weary  and  worn  invalid  from  the  little 
spot  he  calls  "  home  "  to  a  hospital  or  other  asylum  for  poverty, 
deprive  him  of  his  friends,  neighbors,  and  companions,  and  all 
the  little  endearing  sympathies  and  solaces  of  domestic  life,  re- 
strict his  freedom  by  prison  discipline  and  half-way  imprison- 
ment, and  subject  him  to  the  sense  of  friendlessness  that  is  too  apt 
to  seize  the  mind  in  the  hours  of  sickness,  and  to  the  foul  effluvia 
and  diseased  emanations  that  lurk  about  the  wards  of  large  and 
overcrowded  hospitals,  and  to  the  risk  of  rugged  indifference  on 
the  part  of  paid,  possibly  coarse,  nurses,  and  to  irksome,  hum- 
drum, hospital  rules — to  bed,  to  meals,  to  everything  at  the 
sound  of  the  bell,  gong,  or  whistle  ;  to  expose  him  possibly  to  the 
public  gaze,  merely  as  an  object  of  medical  treatment,  or  for 


200  THE    PHYSICIAN    HIMSELF  I 

experiment  with  new  remedies,  or  for  the  dinical  advantage  of 
medical  students,  designate  liim  by  a  number,  clothe  him  hospital 
fashion,  and  put  him  on  diet  prepared  at  regulation  hours  by 
stranger  hands  that  know  not  his  peculiarities  or  tastes,  his  likes 
and  dislikes — if  he  be  a  person  of  domestic  tastes  and  sensitive 
disposition,  with  a  natural  attachment  to  his  home  and  its  sur- 
roundings, such  a  change  would  be  most  hurtful  and  injudicious^ 
and  could  scarcely  fail  to  aggravate  his  disease.  Worse  still,  if 
he  be  carried  to  a  medical-college  hospital,  with  its  busy  crowds 
shuffling  feet,  wilderness  of  gazing  eyes,  and  sea  of  eager  faces 
gathered  around  while  he  is  used  as  a  subject  for  the  demon- 
stration of  his  disease,  or  carried  through  repeated  or  prolonged 
examinations  for  the  education  of  students. 

The  belief  that  taking  water  or  ice  is  dangerous  in  fever  is 
still  very  general.  People  are  wonderfully  slow  to  recognize  the 
fact  that  water,  whether  applied  externally  or  sipped  and  swal- 
lowed in  small  quantities  at  a  time,  is  one  of  nature's  greatest 
remedies  in  fever,  especially  if  the  patient  have  a  craving  for  it. 

If  a  person  perspire  more  during  sleep  than  at  any  other 
time  it  is  a  sure  sign  of  weakness. 

You  will  often  be  asked,  "•  Doctor,  may  the  patient  eat  any- 
thing he  wishes  ? "  If  you  think  that  ordinary  food  will  do 
him  no  injury,  be  careful  to  answer,  "  Yes ;  he  can  have  any 
simple  thing  he  wishes."  Were  you  to  say,  "  He  can  have  any^ 
tJiing,"  it  would  include  pickles,  radishes,  cheese,  ham,  veal, 
sausage,  and  a  great  many  other  indigestible  things  that  might 
injure  or  kill  him ;  the  addition  of  the  adjective  simple  will 
protect  both  him  and  you. 

You  can  have  a  small,  single-page  diet-list  printed  for  the 
use  of  patients,  containing  every  article  of  diet  in  common  use, 
alphabetically  arranged,  at  the  top  of  which  you  can  say, 
"  Every  article  on  this  list  is  forbidden  except  those  that  are 
marked."  Supply  one  to  each  patient  requiring  it,  and  mark  or 
erase  from  time  to  time  such  articles  as  you  deem  proper. 

When  you  are  busy  and  wish  to  make  a  short  visit,  do  not 


HIS   REPUTATION   AND    SUCCESS.  201 

tell  the  patient  so  on  entering,  or  exhibit  a  hurried  or  abrupt 
demeanor,  but  begin  promptly  to  ask  the  necessary  questions  in 
orderly  relation,  and  do  not  allow  the  patient  time  to  introduce 
other  subjects,  or  in  any  way  digress  from  his  case  until  you 
have  learned  all  that  is  necessary.  Have  neither  eyes  nor  ears 
for  anything  except  your  patient.  If  the  subject  of  the  weather 
is  broached,  answer  as  if  you  were  considering  it  only  in  refer- 
ence to  its  influence  on  the  patient  before  you,  then  go  back  to 
his  case.  Economize  time  thus;  but  if  your  patient  is  ill, 
neither  allude  to  your  haste  nor  in  any  way  show  that  you  are 
in  a  hurry  until  you  have  made  your  examination  and  written 
your  prescription.  After  completing  the  circle  of  duty  and  giv- 
ing all  the  attention  absolutely  required,  if  you  courteously  de- 
part forthwith,  he  will  not  feel  that  your  haste  has  caused  any 
inattention  to  his  case,  as  he  would  if  you  had  leaped  into  his 
room  precipitately,  thrown  down  your  hat  and  gloves,  dropped 
into  a  chair,  asked  a  few  h.urried,  desultory  questions,  made  an 
incomplete  examination,  jumped  to  your  diagnosis,  scribbled  off 
a  prescription,  leaped  into  your  carriage,  and  hurried  away. 

Unless  there  is  an  obvious  reason  for  an  opposite  course,  it 
is  better  to  avoid  all  desultory  conversation  on  general  subjects 
at  the  beginning  of  your  visits. 

It  will  often  vex  you,  when  you  are  busy  and  time  is 
precious,  to  be  kept  waiting  below  stairs  while  the  people  in 
the  sick-room  prim  and  prepare  to  receive  you  with  as  much  pru- 
dery and  tedious  ceremony  as  if  the  surroundings,  rather  thau 
the  patient,  were  the  object  of  your  visit.  Show  every  one  the 
respect  due  to  sex  and  rank,  but  manage  at  the  same  time  to 
let  such  people  know  that  your  time  is  too  precious  to  be  waste- 
fully  expended,  and  must  be  divided  somewhat  equally  among 
those  whom  you  are  attending. 

Never  assign  as  a  reason  for  being  habitually  late  in  visiting 
an  ill  patient  that  you  are  overbusy.  Every  one  wants  a  phy- 
sician who  is  in  active  experience  and  engrossed  in  practice,  but 
no  one  likes  to  be  habitually  slighted  or  crowded  out.     A  case 


202  THE    PHYSICIAN    HIMSELF: 

of  obstetrics  or  an  accident  is,  however,  deemed  by  all  an  accept- 
able excuse.  It  is  an  excellent  rule  always  to  let  patients  know 
at  your  visit  when  they  may  expect  your  next  visit,  and  to  keep 
your  engagement  as  near  to  the  time  as  circumstances  will  allow. 
Such  a  system  gives  satisfaction  and  prevents  anxiety,  and  you 
will  then  generally  find  them  prepared  to  see  you  without 
detention  or  flurry. 

It  is  very  important  always  to  ask  to  see  the  patient's 
medicine  as  soon  as  possible  at  your  visit,  and  to  ascertain  by 
both  inspection  and  inquiry  whether  it  has  been  taken  according 
to  your  directions  before  you  express  any  opinion  of  the  patient's 
progress.  If  you  neglect  to  do  so,  you  may  be  caught  confi- 
dently ascribing  improvements  to  prescriptions  that  have  not 
been  used,  or  to  remedies  that  have  either  been  thrown  out  of 
the  window  or  emptied  into  the  garbage-box,  and  you  will 
become  the  victim  of  a  never-to-be-forgotten  joke. 

School  yourself  to  avoid  cruda  remedies  and  to  cultivate 
conservative  rather  than  radical  ones.  Throw  gross  physic  to 
the  dogs.  A  repute  for  not  being  heroic  in  treatment  and  not 
giving  much  strong  medicine  is  at  this  time  a  telling  item  in  a 
physician's  reputation,  one  that  might  almost  be  adopted  as  a 
corner-stone.  Of  course,  in  cases  in  which  duty  actually  re- 
quires you  to  act  promptly  and  decisively,  or  to  use  powerful 
remedies  heroically,  you  must  not  hesitate  to  take  the  respon- 
sibility and  do  whatever  is  right  and  proper. 

Avoid  polypharmacy.  It  is  much  better  to  order  some 
single  remedy,  or  a  combination  of  which  you  know  the  physi- 
ological effect,  than  to  order  an  indefinite  medley  on  the  ancient 
blunderbuss  principle. 

It  is  highly  proper,  and  a  duty,  to  warn  people  of  dangers 
to  the  public  health,  and  to  devise  means  to  prevent  or  remove 
such  dangers ;  also,  to  teach  patients  the  importance  of  regular 
living ;  proper,  careful  diet,  good  water,  pure  air,  effective  drain- 
age ;  also,  of  the  dangers  that  may  follow  the  sun's  rays  and 
evening  dews,  that  they  may  escape  disease  and  preserve  health; 


HIS   REPUTATION    AND    SUCCESS.  203 

l3ut  it  is  neither  just  nor  wise  to  teach  other  than  medical  students 
the  secrets  of  our  art,  nor  to  famiUarize  tlie  laity  with  the 
drugs  you  employ.  You  should  especially  avoid  giving  self- 
sufficient  people  therapeutical  information  that  they  can  there- 
after resort  to  and  ignore  the  physician.  If  you  do,  they  will 
soon  feel  brimful  of  wisdom,  become  opinionated,  and  imagine 
they  know  as  much  about  medicine  as  you  do,  or  than  all  our 
profession  combined,  and  begin  amateur  prescribing  and  neigh- 
borly doctoring,  and  not  only  take  your  bread  from  you,  but 
make  hobbies  of  what  you  have  taught  them,  and  trifle  with 
serious  affections  until  the  patient's  disease  is  fatally  seated ; 
after  which  even  correct  treatment  may  be  interrupted  by  the 
undertaker.  It  is  your  duty  to  cheat  neither  yourself  nor  other 
physicians  out  of  legitimate  practice  by  supplying  this  person 
or  that  one  with  a  word-of-mouth  pharmacopoeia  for  general 
use.  If  compelled  to  give  a  person  remedies  under  a  simple 
form,  study  to  do  so  in  such  a  way  as  not  to  increase  his  self- 
conceit,  and  make  him  feel  that  he  knows  enough  to  practice 
self-medication  and  dispense  with  your  services ;  and  use  what- 
ever strategy  is  necessary  to  prevent  him  from  taking  unfair 
advantage  of  your  prescriptions. 

It  is  unwise  to  instruct  a  person  with  rheumatism,  gonor- 
rhoea, ulcers,  sore  mouth,  sprains,  or  any  other  affliction,  to  get 
"five  or  ten  cents'  worth  of  this  or  that  remedy,  to  mix  for  him- 
self, unless  it  be  one  of  the  worthy  poor ;  for  people  are  sure  to 
become  self-constituted  doctors  and  abuse  such  instructions,  and 
try  to  teach  others  similarly  afflicted  how  to  treat  themselves. 

"Every  sore-eyed  person  is  an  oculist." 

It  is  better  to  let  such  persons  have  the  medicine  from  your 
office,  or  to  write  a  prescription  for  it,  with  instructions  neither 
to  repeat  nor  lend. 

It  is  also  better  to  make  your  analysis  of  urine,  etc.,  at  your 
v)wn  office  rather  than  at  the  patient's  house,  and  to  keep  the 
details  of  the  processes,  reagents  used,  points  of  differentiation, 


204  THE   PHYSICIAN    HIMSELF: 

and  other  secrets  of  the  art,  etc.,  to  yourself;  else  Keensighfc 
and  his  friends  will  quickly  become  oversmart,  begin  to  test  for 
themselves,  and  think  they  know  more  than  they  really  do. 

"The  silent  man  has  many  things  in  his  favor." 

In  prescribing,  and  even  in  talking  of  medicines,  you  should 
use  officinal  and  not  popular  names,  unless  there  is  some  special 
reason  for  using  the  vulgar,  or  a  synonym. 

Confine  your  prescriptions  to  officinal  medicines,  and  to 
preparations  whose  formulas  are  public  property,  as  fully  as  pos- 
sible, and  do  not  patronize  any  of  the  semi-legitimate  pharma- 
ceutical catchpennies  (about  which  you  know  nothing  but  what 
their  labels  and  wrappers  tell)  that  are  now  flooding  our  nostrum- 
ridden  land.  For  instance,  if  a  patient  needs  beef,  let  him  eat 
beef,  or  have  beef-soup,  or  beef-tea,  or  beef-extract  made  for 
him  ;  if  he  needs  wine,  order  for  him  a  suitable  quantity  of  the 
kind  which  you  prefer  ;  if  he  needs  iron,  prescribe  the  kind  and 
the  dose  that  you  think  proper,  and  thereby  prevent  making 
yourself  a  mere  distributor  of  some  enterprising  fellow's  ready- 
made  "  beef,  wine,  and  iron,"  which  cheats  the  pharmacist  out 
of  all  chance  of  exercising  his  proper  profession,  and  frees  him 
from  all  mental  exertion  and  all  responsibility  in  the  matter, 
since  he  and  his  apprentice  boy  have  nothing  to  do  but  serve  as 
dealers,  and  hand  it  out  to  customers,  just  as  the  grocer  and  his 
clerks  hand  out  salt  and  sugar,  soap  and  candles,  molasses  and 
tobacco. 

The  same  hat  cannot  fit  every  head,  or  the  same  shoe  every 
foot,  neither  can  the  proportion  of  ingredients  in  any  ready- 
made  combination  suit  every  patient.  Indeed,  what  would  cure 
one  might  injure  or  kill  another. 

"What  has  cured  Sancho  might  kill  Martha." 

Let  it  be  your  firm  resolve  never  to  prescribe  a  proprietary 
remedy,  or  one  covered  by  a  trade-mark ;  it  is  better  to  shun  all 
such  ready-prepared  remedies,  whether  trade-mark,  proprietary, 
or  quack,  whether  advertised  to  the  profession  or  to  the  public, 
whether  the  so-called  formula  and  the  dose  are  given  or  not.    If 


HIS   REPUTATION   AND    SUCCESS.  205 

you  order  A.'s  emulsion,  B.'s  lozenges,  C.'s  codliver-oil,  D.'s 
pills,  and  E.'s  bitters  to  patients,  they  will,  by  association,  soon 
think  that  X.'s  sarsaparilla,  Y.'s  buchu,  and  Z.'s  liver  regulator 
also  meet  with  professional  approval.  Determine  that  you  will 
not  aid  any  speculator  in  life  and  health  to  "  strike  a  trade  "  in 
your  families ;  and  chiefly  for  the  reason  that  tlieir  nostrums  do 
more  harm  than  good  ;  also  for  the  lesser  reason  that  justice  to 
yourself  and  to  all  other  members  of  the  profession  requires  you 
to  avoid  prescribing  or  telling  patients  of  preparations  that  will 
enable  them  subsequently  to  snap  their  fingers  in  your  face  and 
renew  them  as  often  as  they  please,  and  to  recommend  them  to 
others  who  treat  themselves  with  them  without  your  aid.  A 
single  trade-mark  prescription  from  you  may  sell  twenty  or  a 
hundred  bottles  that  you  do  not  prescribe,  and  for  which  you 
get  neither  credit  nor  compensation. 

Endeavor  to  have  your  prescriptions  labeled  so  as  to  pre- 
vent indiscriminate  renewal,  as  well  as  to  prevent  mistakes  in 
their  administration ;  when  they  are  very  important,  be  careful 
to  have  the  name  of  the  patient  put  on  the  label,  that  every  one 
may  know  whose  medicine  it  is. 

Remember  this :  The  very  best  time  to  tell  a  patient  not  to 
renew  a  prescription  is  while  writing  it.  If  you  fear  it  will  be 
renewed  against  your  wish,  stop  short  while  writing  and  explain 
to  him  why  it  will  be  a  good  remedy,  or  make  some  other  true 
remark  about  it,  but  that  he  must  take  only  one  bottle  of  it,  or 
that  it  must  not.  be  renewed.  Your  order  given  at  that  time 
will  seem  to  be  founded  on  some  motive  other  than  that  of  pro- 
tecting your  own  pecuniary  interest,  will  impress  him  strongly, 
and  will  be  invariably  obeyed ;  this  is  probably  the  most  effect- 
ive of  all  plans  to  prevent  prescriptions  from  being  renewed 
and  adopted  as  a  regular  resort  in  similar  cases.  With  this  ex- 
ception, make  it  a  rule  neither  to  talk,  listen,  nor  answer  ques- 
tions while  writing  prescriptions. 

Never  write  a  prescription  carelessly.  Legibility  is  the  first 
requirement,  neatness  the  second.     Cultivate  the  habit  of  scru- 


506  THE    PHYSICIAN    HIMSELF: 

tinizing  everything  you  write  after  it  is  written,  to  assure  your- 
self  that  there  is  neither  omission  nor  error,  and  sign  your  name 
or  initials  to  every  prescription,  but  not  until  you  have  satisfied 
yourself  that  it  is  as  intended.  Mistakes  are  seldom  discovered 
unless  at  the  moment  of  their  occurrence. 

In  consultation,  the  prescription  agreed  upon  should  be 
written  by  the  regular  attendant,  and,  if  the  consultant  is  still 
present,  should  be  offered  to  him  for  inspection ;  but  only  the 
regular  attendant's  name  or  initials  should  be  signed  to  it. 

A  very,  very  useful  rule  in  many  cases  is  to  specify  the 
hours  at  which  medicine  is  to  be  taken ;  thus,  if  it  is  to  be 
taken  every  five  hours,  instead  of  writing  "  a  teaspoonful  every 
five  hours,"  write  "Take  a  teaspoonful  at  seven,  twelve,  five,  and 
ten  o'clock  daily,"  taking  care  that  the  specified  hours  do  not 
interfere  with  those  for  nutriment,  and  be  especially  careful  to 
give  instructions  as  to  whether  the  patient  is  to  be  awakened 
at  night,  or  from  refreshing  day-slumber,  either  for  medicine  or 
food. 

In  giving  directions  in  regard  to  doses,  bear  in  mind  that 
spoons  and  drops  vary  greatly  in  size.  Much  trouble  and  un- 
certainty can  be  avoided  in  cases  where  medicine  will  have  to 
be  taken  for  any  length  of  time  by  getting  a  graduated  medi- 
cine-glass, which  is  both  convenient  and  precise.  A  minim  is  a 
definite  quantity,  a  drop  is  not ;  therefore,  in  prescribing  potent 
fluids,  you  should  order  minims  instead  of  drops. 

Neither  alarm  your  patients  nor  their  friends,  nor  risk  the 
dangers  of  the  chloral,  opium,  or  other  bad  habit  being  ac- 
quired, by  allowing  the  sick  to  know  that  they  are  taking  such 
remedies. 

If  vou  instruct  a  patient  how  to  use  the  hypodermatic  syringe 
on  himself,  or  to  inhale  chloroform  or  ether,  or  give  him  cocaine, 
chloral,  opium,  alcoholic  liquors,  or  other  exhilarating  and  fas- 
cinating agents  without  discrimination,  or  to  use  according  to 
his  own  judgment,  if  he  have  any  predisposition  toward  them  he 
will  probably  acquire  the  habit ;  and  if  he  does,  you  will  surely 


HIS   REPUTATION    AND    SUCCESS.  207 

and  deservedly  incur  the  blame.  The  slaves  of  such  blighting 
habits  always  cast  the  blame  for  their  acquired  passion,  or  their 
withering  enslavement,  on  the  physicians  who  first  ordered  the 
drug  or  stimulant  for  them,  if  they  have  the  least  ground  for 
doing  so. 

Hypodermatic  medication  not  only  has  its  place  as  a  valu- 
able remedial  agent,  but  at  times  becomes  really  indispensable ; 
it  also  has  various  drawbacks  that  should  prevent  its  indiscrim- 
inate use.  Among  the  lesser  evils  connected  with  it  is  that 
those  who  are  soothed  and  temporarily  comforted  by  it,  or  have 
become  habituated  to  it,  are  apt  to  harass  and  worry  you  for  its 
application  at  all  hours,  day  and  night ;  and  you  will  often  find 
it  a  real  hardship,  after  doing  your  day's  work,  to  be  obliged  to 
go  and  administer  a  hypodermatic  (night-cap)  of  morphia  to  the 
Kev.  Mr.  Cantsleep  at  eight  o'clock  p.m.,  to  Mrs.  AUnerves  at 
nine,  to  Colonel  Bigdrinks  at  ten,  and  to  Miss  Narywink  at 
eleven  o'clock,  and  probably  be  called  from  bed  again  to  insert 
the  sleep-giving  needle  for  one  or  all  of  them  before  morning, 

Much  of  such  work  is  not  only  a  hardship  but  a  nuisance. 
Far  better  is  it  for  both  the  patient  and  yourself  that  anodynes 
be  administered  by  the  mouth  or  rectum  in  such  cases,  than  for 
you  to  have  all  this  extra  trouble,  and  at  the  same  time  expose 
him  to  what  may  prove,  to  him,  a  fatal  charm,  and,  to  you,  a. 
sorrowful  lesson. 


CHAPTER  VIII. 

"Call  not  on  Hercules  for  help  ;  his  aid 
Ne'er  serves  the  man  who  will  not  serve  himself. 
Thine  own  arm  must  the  conflict  meet, 
Thy  purpose  being  the  victory." 

It  does  not  require  the  eye  of  a  Newton  or  the  brain  of  a 
Bacon  to  discover  that  self-reliance  and  self-possession  are  capi- 
tally important  elements  of  success.  Nothing  under  the  sun 
will  cause  people  to  believe  in  and  rely  on  you  more  readily  and 
permanently  than  to  see  you  believe  in  and  rely  on  yourself 
Your  own  faith  will  promote  faithfulness.  Be  not  arrogant  or 
self-conceited,  and  exhibit  neither  rashness  nor  weakness,  but 
cultivate  self-reliance  and  the  power  of  thinking  and  acting  in 
the  midst  of  excitement  and  distracting  forces,  and  endeavor  to 
conceal  all  doubts,  hesitations,  uncertainties,  self-distrust,  and 
apprehensions  as  completely  as  possible. 

"The  wise  and  brave  conquer  difficulties 
By  daring  to  attempt  them." 

Never  turn  your  cases  over  to  "  specialists,''^  but  keep  them 
under  your  own  watchful  supervision,  unless  they  present  features 
which  render  it  an  actual  duty  to  do  so.  If  you  distrust  your 
own  capacities,  shrink  and  shirk  and  timidly  refer  your  cases 
of  eye  disease  to  the  oculists,  your  uterine  cases  to  the  gynaecol- 
ogists, ear  cases  to  aurists,  surgical  to  surgeons,  nervous  affec- 
tions to  neurologists,  throat  complaints  to  laryngologists,  mental 
afflictions  to  alienists,  skin  diseases  to  dermatologists,  crooked 
legs  and  stubbed  toes  to  orthopaedists,  warts  to  a  manicure,  and 
so  on  throuofhout  the  list  of  "  olog^ies,"  vou  will  lessen  vour 
own  field  of  activity,  and  instead  of  gaining  as  much  experience 
with  one  affection  as  another,  and  becoming  many-sided  and 
armed  at  all  points, — 

"Dexterity  comes  by  experience," — 

you  will  soon  lose  all  familiarity  with  the  diseases  that  specialists 
(208) 


HIS   REPUTATION    AND    SUCCESS.  209 

treat,  they  will  be  "  out  of  my  line,"  and  you  will  dwindle  and 
degenerate  into  a  mere  distributor  of  cases, — 

"One  starts  the  hare,  another  bags  it," — 

a  medical  adviser  instead  of  a  medical  attendant, — advancing 
everybody's  professional  and  pecuniary  interest  except  your  own, 
aiding  them  to  gain  the  admiration  of  the  community,  and  to 
make  reputation  and  fees  out  of  that  which  sinks  your  own 
individuality,  robs  your  own  purse,  and  throws  (little)  you  into 
the  shade.  A  good  rule  is  this  :  Consult,  in  cases  of  irreducible 
strangulated  hernia,  stone  in  the  bladder,  and  in  all  other  capital 
operations,  if  you  yourself  are  not,  a  good  operator ;  also,  when- 
ever a  serious  case,  whether  in  head  or  body,  hand  or  foot, 
puzzles  or  defeats  your  judgment,  or  proves  wholly  unmanage- 
able by  usual  treatment,  or  is  so  grave  in  prognosis  as  undoubt- 
edly to  require  broader  shoulders  than  yours  to  bear  the 
responsibility,  either  call  in  a  specialist  to  aid  in  its  manage- 
ment, or,  if  need  be,  turn  it  over  entirely  to  him.  If  you  study 
all  the  branches,  and  keep  yourself  abreast  of  the  times,  such 
occasions  will  soon  be  very  rare  to  you.  Timidity,  from  a  want 
of  confidence  in  one's  own  merits,  and  rashness  are  both  bad  traits 
in  a  physician,  but  the  former  is  the  greater  drawback,  since 
every  physician's  success  must  be  within  himself  and  must  come 
out  of  himself,  and  he  must  not  only  have  knowledge  in  his 
head,  but  he  must  have  it  at  his  fingers'  ends  and  on  his  tongue's 
end,  and  must  not  only  know  how  to  do  a  thing,  but  must  also 
believe  that  he  is  able  to  do  it. 

Whenever  you  transfer  any  one  from  your  care  to  a  special- 
ist's, always  do  so  either  by  a  consultation,  a  letter,  or  a  per- 
sonal interview  with  him,  so  that  he  may  learn  directly  from  you 
your  diagnosis,  prognosis,  treatment,  etc.  You  will  thereby 
give  him  the  advantage  of  your  knowledge  of  the  case,  and  also 
avoid  the  risk  of  any  injury  to  your  reputation  from  an  appar- 
ently radical  difference  of  opinion  between  him  and  yourself; 
it  will  also  secure  your  graceful  retirement  from  the  case.  At 
the  same  time,  be  careful  to  make  your  patients  fully  understand 


210  THE   PHYSICIAN    HIMSELF: 

that  in  turning  their  cases  over  to  a  surgeon  or  specialist  you 
have  only  turned  them  over  for  that  special  ajfection^  and  do 
not  cease  to  be  their  physician  in  any  future  sickness. 

Ask  for  a  consultation  in  all  important  cases  in  which 
singular  difficulty,  or  obscurity,  or  knotty  problems  are  pre- 
sented, or  where  any  doubt  exists  as  to  the  diagnosis ;  also,  when 
you  are  in  doubt  as  to  the  propriety  of  a  surgical  operation,  and 
in  all  cases  in  which  you  think  either  the  patient's  interest,  his 
lack  of  improvement,  the  appearance  of  fresh  or  puzzling  symp- 
toms, or  a  division  or  sharing  of  the  responsibility  demands 
it ;  for  then,  another  eye,  or  a  different  mind,  or  an  older  or 
more  experienced  hand,  may  be  of  great  service.  When  from 
any  cause  you  see  that  confidence  in  you  is  wavering,  or  that 
necessity  for  a  consultation  is  arising,  endeavor  to  anticipate  the 
family  by  being  the  first  to  propose  it. 

Do  not  conclude  that  a  request  for  a  considtation  always 
implies  a  mistrust  of  your  knowledge  and  skill,  for  it  is  oftener 
due  to  the  natural  anxiety  of  the  patient's  family  and  friends. 
We  often  perceive  the  limits  of  our  own  resources,  and,  sympa* 
thizing  with  the  patient's  friends  as  to  the  result  of  the  ill- 
ness, are  most  willing  and  anxious  for  a  consultation.  On  the 
other  hand,  when  they  wish  a  consultation,  they  should  respect 
your  feelings  and  susceptibilities,  and  make  known  their  wish  to 
you,  instead  of  taking  you  by  surprise  by  springing  a  consultant 
upon  you  without  notice  ;  they  should,  indeed,  never  send  for  a 
consulting  physician  without  your  express  consent,  yet,  when  it 
is  done  through  their  ignorance  of  ethics,  the  discourtesy  had 
better  be  condoned  and  the  consultation  held,  for  were  you  to 
decline  to  join  a  consultation  under  such  circumstances  you 
would  incur  a  grave  responsibility. 

Consultations  lessen  personal  responsibility  and,  in  some 
degree,  anxiety.  Besides,  they  are  highly  profitable  to  the  pro- 
fession in  more  ways  than  one,  and  conducive  to  the  advantages 
of  the  sick.  When  you  chance  to  have  bad  surgical  and  other 
cases,  or  an  operation  in  which  life  will  be  risked,  or  difficult 


HIS   REPUTATION    AND    SUCCESS.  211 

or  complicated  cases  of  midwifery,  or  great  or  anomalous  cases 
of  any  kind  among  your  personal  friends  or  relatives,  or  so 
near  home  as  to  involve  you  personally  or  socially ;  or  in  a 
neighborhood  in  which  a  group  of  patients  is  likely  to  be  un- 
favorably impressed  if  the  result  be  unfortunate,  it  is  especially 
necessary  and  judicious  to  call  in  a  consulting  physician  or  sur- 
geon to  lighten  your  burden,  even  though  you  have  him  to  come 
for  but  a  single  visit, — to  satisfy,  if  for  no  other  reason,  the 
persons  concerned. 

If  possible,  always  select  high-minded,  honorable  physicians 
as  consultants,  who  will  second  your  efforts  by  their  skillful 
knowledge,  and  at  the  same  time  be  likely  to  harmonize  with 
you  in  the  management  of  your  cases ;  for  their  kindly  sym- 
pathy and  co-operation  may  be  highly  necessary  to  the  welfare 
of  the  patient  and  to  your  own  reputation ;  but,  when  a  con- 
sultation is  held  merely  to  satisfy  a  patient  or  his  friends,  it 
is  then  better  to  throw  the  selection  on  them,  and  to  accept 
whoever  is  offered  to  you,  if  he  be  a  regular  physician  and  a 
gentleman. 

When  you  happen  to  be  the  one  consulted,  do  not  enter 
the  sick-chamber,  or  examine  the  patient  before  your  conferree's 
arrival,  or  ask  him  questions,  except  in  the  presence  of  your 
conferree,  and  have  all  communications  in  his  presence. 

Be  punctual  to  the  minute  in  keeping  consultation  engage- 
ments. You  have  no  right  to  waste  another's  time  in  such 
cases,  or  to  impose  upon  him  the  necessity  of  awaiting  idly  for 
you  at  the  place  of  meeting. 

Under  ordinary  circumstances  it  rests  with  the  consulting 
physician  and  not  with  the  regular  attendant  to  name  the  hour 
of  meeting. 

In  your  earlier  consultations  you  Avill  often  feel  no  little 
anxiety  and  suspense  while  waiting  to  see  whether  the  consult- 
ant will  act  fairly  toward  you  and  strive  to  hide  your  demerits, 
or  whether  he  will,  by  nod  or  wdnk,  hint,  question  or  innuendo, 
expose  your  deficiencies  to  a  few,  to  be  told  to  many,  until  you 


212  THE   PHYSICIAN    HIMSELF: 

are  reduced  to  a  mere  cipher  in  the  estimation  of  those  to  whom 
the  case  is  related.  To  the  honor  of  our  profession  be  it  said, 
that  the  vast  majority  of  its  older  members  are  not  only  punc- 
tilious, but  really  kind  on  these  occasions,  as  if  still  remembering 
the  anxieties  and  responsibilities  of  their  own  early  professional 
lives. 

A  radical  change  of  diagnosis  and  of  treatment,  or  a  re- 
verse and  opposite  course  in  any  respect,  as  the  result  of  a  first 
consultation,  often  and  very  naturally  impresses  the  laity  with 
the  idea  that  the  previous  diagnosis  or  treatment  has  been  either 
faulty  or  actually  wrong,  and,  therefore,  unless  some  real  neces- 
sity demands  it,  no  material  change  should  be  proposed  or  allowed 
at  that  time.  As  a  rule,  the  fewer  the  apparent  changes  result- 
ing from  a  first  consultation  the  better  for  the  family  attendant, 
and  especially  if  he  be  a  young  physician  with  insecure  repu- 
tation. 

No  physician  who  has  the  least  regard  for  honor  or  principle 
will  persist  in  an  error  of  which  he  is  aware.  If  you  are  ever 
brought  into  contact  with  a  colleague  who,  through  what  appears 
to  be  lack  of  wisdom,  or  from  self-conceit  or  sinister  motives, 
persists  in  differing  from  an  opinion  or  course  that  you  are  sure 
is  correct,  or  insists  on  doing  what  you  believe  to  be  maltreat- 
ment, or  shows  culpable  neglect,  and  you  fear  he  may  injure 
you  thereby,  either  withdraw,  or  insist  on  calling  some  eminent 
member  of  the  profession  into  the  conference,  that  he  may  de- 
cide between  you.  After  that  is  done,  if  you  think  your  inter- 
ests require  it,  you  can  retire  from  the  case  without  discredit. 

When  a  consulting  physician  or  a  surgeon  is  designated 
and  called  at  your  request,  you  should  see  that  the  payment  of 
his  fee  is  not  neglected,  and  you  might  with  propriety  broach 
the  subject  to  those  who  are  to  pay  the  bill,  before  he  quits. 
This  can  be  done  by  privately  informing  them  that  his  charges 
will  probably  be  somewhat  less  if  paid  at  his  last  visit  than  if 
they  wait  for  him  to  send  a  bill,  which  might  then  be  for  the 
maximum  amount. 


HIS   REPUTATION   AND    SUCCESS.  213 

To  prevent  misunderstanding,  it  is,  in  many  cases,  wise  to 
say  a  word  or  two  about  consultant's  fees  to  the  patient  or  his 
friends  at  the  time  the  subject  of  having  a  consultation  is  first 
mentioned. 

You  can,  in  such  a  case,  speak  much  more  plainly  on 
behalf  of  your  brother  physician  called  at  your  instance  than 
you  could  for  yourself  His  relations  to  the  case  presuppose 
him  to  have  nothing  in  view  but  the  welfare  of  the  patient,  and 
to  be  thinking  only  of  the  scientific  and  therapeutical  aspects  of 
the  case,  and  not  of  his  expected  fees.  Prompt  settlement  of 
the  consultant's  fees  will  sometimes  conduce,  moreover,  to  a  more 
prompt  payment  of  your  own. 

Never  make  yourself  responsible  for  the  payment  of  another's 
fee.    Aid  him  in  a  proper  degree  to  get  it,  but  do  nothing  more. 

It  is,  for  several  reasons,  better  for  the  consultant  to  send 
his  bill  before  the  regular  attendant  sends  his ;  when  the  latter 
sends  his  first,  it  looks  as  if  he  is  more  anxious  for  the  safety  of 
his  fees,  hence  is  in  a  greater  hurry  than  the  stranger  is. 

Unless  the  consultant  gets  his  fee  cash  after  the  consulta- 
tion, or  you  are  aware  that  special  arrangements  exist  for  its 
payment,  be  careful  to  inform  the  people,  as  soon  as  his  attend- 
ance ceases,  or  at  any  rate  before  the  time  arrives  for  sen'ding 
them  your  bill,  whether  he  will  render  his  bill  separately  or  not. 
If  you  neglect  to  explain  this  to  them,  they  will  almost  surely 
think  you  ought  to  pay  him  out  of  your  charges,  and  a  mis- 
understanding will  result  as  to  whether  you  or  they  should  pay 
his  bill. 

Whenever,  to  please  the  patient  or  his  friends,  you  are 
forced  to  set  aside  other  duties  in  order  to  meet  another  phy- 
sician in  consultation,  it  is  right  that  you  should  charge  twice  as 
much  for  such  service  as  for  an  ordinary  visit,  or  perhaps  even 
as  much  as  the  consultant  does,  inasmuch  as  consultative  meet- 
ings not  only  involve  extra  time,  but  the  carrying  out  of  the 
details  will  devolve  upon  you  and  entail  additional  trouble,  and 
consequently  you  are  entitled  to  extra  compensation. 


214  THE    PHYSICIAN    HIMSELF  I 

111  dispensing  with  the  services  of  tlie  consultant  when  no 
longer  necessary,  take  care  to  secure  his  acquiescence,  and  make 
him  see  that  it  is  done  with  a  feeling  of  amity  and  good  will. 

In  consultations  it  is  proper  for  the  regular  attendant  to 
precede  the  consultant  in  entering  the  patient's  room,  and  to 
follow  in  leaving  it. 

Friends  of  your  stubborn-case  patients,  who  have  special  con- 
fidence in  their  own  physicians,  will  often  persuade,  and  sometimes 
convince,  them  that  you  do  not  fully  understand  their  affection, 
and  strenuously  advise  them  to  call  in  their  flivorite.  In  such 
cases  remember  that  you  have  no  right  to  object  to  a  patient's  hav- 
ing the  advice  of  any  one  whom  he  particularly  desires  in  addition 
to  your  own  whenever  he  insists  upon  it;  but  also,  tliat  you  have 
a  like  undoubted  right  to  refuse  to  consult  witli  an  irregular  or 
any  one  who  is  antagonistic  to  the  profession,  or  whose  conduct 
you  deem  unprofessional,  or  who  is  unfitted  for  the  case  ;  also, 
any  one  who  is  highly  objectionable  to  you  for  any  other  reason, 
or  in  whose  keeping  you  deem  your  reputation  and  interests 
unsafe.  If  you  are  attending  a  case,  and  such  an  one  is  pressed 
upon  you,  you  have  a  perfect  right  to  retire,  and  should  at  once 
offer  to  withdraw,  and  thus  afford  your  patient  the  liberty  of 
choice  between  you  and  your  rival.  Fortunately,  such  dilemmas 
are  very  rare. 

Do  not  refuse  to  consult  with  foreign  physicians,  doctresses, 
colored  physicians,  or  any  other  regular  practitioners ;  for  you, 
as  a  physician,  hold  a  quasi-official  position  in  the  community, 
and,  in  the  discharge  of  your  duties,  should  know  nothing  of 
national  enmities,  race  prejudices,  political  strife,  or  sectarian 
differences.  Rescue  !  is  our  battle-cry,  and  you,  as  a  physician, 
belong  to  the  world  of  mankind,  and  have  no  moral  right  to 
turn  your  back  on  sick  and  suffering  humanity,  by  refusing  to 
add  your  knowledge  and  skill,  on  a  plane  of  real  and  brotherly 
equality,  to  that  of  any  honorable,  liberal-minded  person  who 
practices  medicine,  if  his  professional  acquirements  and  ethical 
tenets  give  him  a  claim  to  work  in  the  professional  field.     It  is 


HIS   REPUTATION    AND    SUCCESS.  215 

not  only  unmanly  to  make  a  class  distinction  and  throw  obstacles 
in  the  path  of  the  less  favored,  but  such  a  spirit  is  wholly  incom- 
patible with  the  objects  of  our  profession  (which  is  a  liberal  one), 
and  at  direct  variance  with  the  spirit  of  science  (which  is  cosmo- 
politan), and  in  its  efforts  to  diminish  suffering  and  baffle  death 
recognizes  neither  caste,  pride,  nor  prejudice,  and  knows  no 
limits  except  those  of  truth  and  duty. 

But  while  you  bid  "All  Hail!"  and  give  the  right  hand 
of  fellowship  to  every  honorable,  unrestricted  physician,  and 
become  the  friend  and  brother  of  all  the  friends  of  rational 
medicine,  no  matter  what  their  misfortunes  or  how  great  their 
deficiencies ;  you  must,  on  the  other  hand,  remember  that  medi- 
cine is  a  liberal  profession  and  not  a  mere  trade,  and  refuse  to 
extend  the  hand  of  brotherhood  to  any  one  belonging  to  a  party 
or  association  whose  exclusive  system^  narrow  creed,  or  avowed 
or  notorious  hostility  to  our  profession,  prevents  him  from  ac- 
cepting every  known  fact  and  employing  all  useful  remedies, 
whether  dug  from  the  earth,  taken  from  the  air,  or  wrested 
from  the  sea, — to  any  one  and  every  one  who  cannot  honestly 
say  his  mind  is  wide  open  for  the  reception  of  all  medical 
truths,  and  that  his  hand  shall  not  refuse  to  use  anything  and 
everything  under  the  blue  vault  of  heaven  that  may  be  needed 
to  relieve  suffering  and  save  the  life  of  a  human  being;  as  that 
constitutes  a  voluntary  disconnection  from  the  profession. 
When  called  in  to  a  case  in  which  the  medical  attendant 
cannot  do  this,  you  cannot  agree  with  him,  and  must  let  his 
retirement  be  one  of  the  conditions  on  which  you  will  assume 
charge. 

You  may,  however,  be  called  to  a  case  of  pressing  emergency, 
such  as  an  alarming  haemorrhage,  poisoning,  drowning,  choking, 
convulsions,  or  difficult  labor,  and  find  on  your  arrival  that  an 
irregular  practitioner  or  quack  is  in  attendance,  with  whom  you 
are  thus  brought  face  to  face.  In  such  urgent  cases  the  path 
of  duty  is  plain,  for,  owing  to  the  great  danger  to  life,  the 
higher  law  of  humanity  will  require  you  temporarily  to  set  aside 


216  THE    PHYSICIAN    HIMSELF: 

ethics  and  etiquette,  and  to  unite  your  efforts — head,  heart,  and 
hand — with  those  of  your  chance  associate.  Treat  liim  with 
courtesy,  but  studiously  avoid  formal  consultations,  or  private 
professional  dealings,  or  whispering  conversation  with  him,  or 
any  other  act  that  might  imply  association  in  consultation. 

Thus,  you  see,  there  is  not  only  no  antagonism  between 
medical  ethics  and  humanity,  but  that  they  overlook  all  ques- 
tions of  etiquette,  and  allow  and  cover  any  and  every  act  hon- 
estly performed  for  the  benefit  of  humanity. 

Fortunately,  the  indications  for  rational  treatment  are 
generally  so  very  clear  in  such  cases  that  no  one  can  ignore 
them.  If  the  Irregular  has  assumed  charge  before  your  arrival, 
and  is  pursuing  proper  treatment,  or  assents  to  the  proper  treat- 
ment suggested  by  you,  that  is  all  you  can  ask ;  for  instance,  if 
the  patient  has  received  a  terrible  burn,  and  linseed-oil  and  lime- 
water  or  a  strong  solution  of  soda  are  being  applied,  or  other 
rational  treatment,  indorse  it,  and  advise  its  continuation ;  but 
if  your  accidental  colleague  is  a  hydropath,  and  wrongly  insists 
on  a  wet-pack  because  he  is  morbid  on  the  use  of  water,  or 
one  who  obstinately  advocates  a  lotion  of  cantharides  because 
they  burn  and  blister  people  in  health,  it  is  your  duty  to  your 
patient,  and  to  yourself  also,  unyieldingly  to  insist  that  a 
rational  course  shall  be  pursued  if  you  are  to  take  part  in  the 
case.  Be  cautious  and  firm  in  dealing  with  such  contingencies, 
and  it  is  a  duty  which  you  owe  both  to  yourself  and  to  your 
profession  that  you  terminate  the  accidental  and  unnatural  con- 
nection— in  a  gentlemanly  way,  of  course — as  soon  as  the 
pressing  urgency  will  admit. 

Some  unreasoning  people  may  think  you  are  illiberal  in 
refusing  to  fraternize  and  consult  with  Irregular  practitioners, 
regardless  of  the  fact  that  they  have  voluntarily  divorced  them- 
selves from  the  profession  and  boastingly  assumed  a  name 
intended  to  notify  the  public  that  their  system  differs  from 
ours;  and,  moreover,  that  they  are  hostile  to  it  and  to  us.  Bear 
in  mind  that  our  refusal  does  not  arise  from  a  false  sense  of 


HIS    REPUTATION   AND    SUCCESS.  217 

dignity  or  from  prejudice,  but  that  the  great  principle  which 
underlies  it  is  this :  as  lovers  of  all  medical  truths^  we  have  no 
fixed,  no  unchangeable  creed,  but  hail  with  delight  every 
etiological  and  therapeutical  discovery,  no  matter  by  whom 
made,  and  take  by  the  hand  and  recognize  as  a  brother  any 
one  who  is  liberal  enough  to  consecrate  his  life's  labor  to  the 
relief  of  the  sick  ;  but  when  we  know  that  a  certain  person, 
even  if  he  has  an  armful  of  diplomas,  circumscribes  himself  to 
half  a  truth  and  practices  a  botanical  system  only,  or,  like  a 
pigeon  with  but  one  wing,  a  vitopathic  system  only,  or  a  hydro- 
pathic system  only,  or  an  omniopathic  system  only,  or  an  elec- 
tropathic  system  only,  or  any  other  one-idea  system  only,  and  is 
so  tied  down  and  limited  to  that,  by  his  love,  bigotry,  or  preju- 
dice that  he  denies  the  usefulness  of  all  other  known  and  legiti- 
mate  means  of  aiding  the  sick,  and  endeavors  to  poison  the  public 
mind  against  all  other  therapeutics  but  his  own, — all  rational 
physicians  esteem  such  an  one  as  too  illiberal  to  be  a  true  phy- 
sician, and  justly  exclude  him  as  unworthy  of  fellowship  with 
those  who  profess  to  love  all  truth,  and,  whilst  he  remains  im- 
prisoned within  his  own  ball-and-chain  system,  themselves 
endeavor  to  steadily  pursue,  with  perhaps  less  zeal,  but  with 
more  sense,  the  path  of  true  science  and  progress. 

If,  on  the  other  hand,  he  uses  the  remedies  that  rational 
medicine  supplies,  yet  adopts  the  cloak  of  an  "  ism  "  simply  as 
an  advertising  dodge, — 

"Blow,  blow,  bugle  blow," — 

to  make  the  public  believe  that  he  practices  in  some  manner 
diametrically  opposite  to  our  system,  and  thereby  assists  our 
opponents  to  lessen  public  esteem  for  legitimate  medicine  and 
to  create  aversion  to  us  as  its  followers,  he  is  guilty  of  fraud, 
and  you  should,  therefore,  even  on  the  ground  of  morality,  refuse 
to  countenance  him. 

When  people  ask  you  "  what  system  of  medicine  you 
practice,"  you  may  very  properly  reply  that  you  are  simply  a 
DOCTOR  of  MEDICINE,  a  PHYSICIAN,  a  member  of  the  regular  un- 


218  THE    PHYSICIAN    HIMSELF: 

restricted  medical  profession,  that  you  have  no  fixed  orthodoxy, 
helong  to  no  sect,  and  are  hmited  to  no  "  ism,"  "  pathy,"  or 
"  ology ;  "  that  you  stand  on  a  broad,  unsectarian  platform, 
and  are  at  Hberty  to  think  whatever  you  may,  only  seeking  to 
do  your  best  for  every  sick  sufferer  who  trusts  to  your  skill  and 
honor ;  that  you  accordingly  try  to  be  rational,  and,  hke  the 
bee,  take  the  honey  of  truth  wherever  you  find  it ;  that  as 
rational,  hberal  physicians,  the  regular  medical  profession,  to 
which  you  belong,  has  no  branches,  no  sects,  no  dogmas,  and 
bears  no  man's  name,  for  it  is  simply  the  work  of  the  human 
race,  and  is  held  together  solely  by  the  common  bond  of  rational 
medicine ;  that  it  maintains  perfect  freedom  of  opinion  and 
practice,  selects  any  remedy  it  pleases,  in  whatever  dose  it  pleases, 
and  under  whatever  theory  it  pleases,  and,  unlike  the  various 
"  limited  schools,"  has  no  articles  of  faith  which  it  imposes  on 
any  one,  but  accepts  all  truths,  whether  winnowed  from  the 
store-house  of  centuries,  or  discovered,  either  scientifically  or 
empirically,  in  our  own  day;  and  that  you,  as  one  of  its  rep- 
resentatives, stand  ready  to  embrace  and  utilize  any  and  every 
valuable  discovery,  no  matter  when  or  by  whom  made. 

"  I  shall  this  good  lesson  keep, 
As  ■watchman  to  my  heart." 

This   freedom    and   latitude    explains    why   unrestricted 

MEDICINE    IS    ONE    OF    THE    THREE    LIBERAL    PROFESSIONS,    and    wliy 

the  humane  and  benevolent  physician  of  the  body  takes  rank 
with  the  learned  expounder  of  the  law  and  with  the  worthy  man 
who  inculcates  religion,  all  three  uniting  to  protect  the  interests 
of  soul,  body,  and  estate.  Bear  proudly  in  mind,  however,  that 
our  useful  and  excellent  science  is  the  only  one  which  regards 
the  entire  man,  physical,  intellectual,  and  moral ;  for  the  lawyer 
looks  on  a  man  as  a  being  possessing  certain  rights,  and  subject 
to  certain  duties  to  his  neighbors,  whilst  the  divine  looks  on 
man  simply  as  a  moral,  responsible  being,  who  has,  or  should 
have,  a  conscience,  to  which  he  directs  his  ministrations. 

To  this  triad  of  professions  was  long  ago  applied  the  term 


HIS   REPUTATION    AND    SUCCESS.  219 

*'  LIBERAL,"  because  for  their  pursuits,  preventing  and  curing  sin, 
preventing  and  curing  disease,  and  preventing  and  curing  legal 
wrong,  each  of  the  trio  requires  the  utmost  perfection  of  char- 
acter, and  because  the  high-souled  sons  of  law,  religion,  and 
medicine  have  in  all  ages  pursued  their  avocations  as  freemen, 
with  hands  unfettered  and  tongue  untied,  subject  to  no  bonds 
except  those  of  truth  ;  and  yet,  as  if  to  blur  the  grandeur  of  the 
picture,  law  has  its  shysters,  religion  its  hypocrites,  and  medicine 
its  quacks.  If  at  any  time  during  your  career  any  sect,  schism, 
or  one-sided  school  arise,  no  matter  how  great  or  how  humble  its 
pretensions,  if  it  have  even  one  grain  of  life-saving  or  health-guid- 
ing wheat  to  its  bushel  of  chaff,  it  is  your  duty  to  seize  the  grain 
of  wheat,  plant  it  in  the  domain  of  rational  medicine,  and  to 
cast  the  chaff,  brambles,  and  thistles  to  the  winds.  This  deter- 
mination to  enlarge  our  field  of  knowledge  from  all  possible 
source  is  our  life-blood,  our  invincible  strength,  and  our  dis- 
tinction, the  saving  element  that  will  cause  regular,  liberal, 
rational  medicine  to  exist  as  long  as  there  are  sickness  and  suf- 
fering in  the  world,  and  the  great  feature  that  distinguishes  gen- 
uine medicine  from  all  "new  schools,"  "isms,"  and  "pathies." 
Remember  that  we  have  no  secrets,  no  patents,  no  monopo- 
lies ;  and  that  our  books,  our  colleges,  our  laboratories,  our 
lecture-rooms,  our  medicines,  and  the  door  of  the  profession 
itself,  are  open  not  only  to  the  newly  graduated  and  the  regu- 
larly initiated,  but  to  every  one  who  has  the  necessary  edu- 
cational and  moral  qualifications,  even  though  he  may  have 
been  an  outsider,  allied,  whether  from  ignorance  or  choice,  with 
schools  which  are  antagonistic  to  the  profession ;  in  the  latter 
case  it  is  only  necessary  for  the  applicant  to  drop  his  distinguish- 
ing creed  or  system,  abandon  the  hostility  to  the  profession 
which  it  implies,  and  to  allow  ethical  rules  to  govern  his  con- 
duct; therefore,  no  conversion,  no  standard  of  orthodoxy,  no  sur- 
render of  private  opinion  or  of  favorite  theories,  or  hypotheses, 
or  of  unlimited  freedom  to  practice  as  he  chooses,  is  at  all  neces- 
sary, and  each  and  all  such  should  be  individually  invited  to 


220  THE   PHYSICIAN    HIMSELF: 

cease  to  foster  irrational,  absurd,  and  credulous  doctrines,  and 
embrace  true,  rational,  scientific  medicine. 

Be  religiously  exact  in  everything  that  relates  to  consulta- 
tions. Let  them  always  be  conducted  in  proper  form,  and  strictly 
private  ;  before  entering  the  patient's  room  give  the  consultant 
a  brief  sketch  of  the  history  and  treatment  of  the  case,  then 
invite  him  in  to  a  chair  at  the  bedside ;  after  making  the  neces- 
sary examination  and  inquiries,  retire  and  consult,  within  a 
room  that  is  private  and  exempt  from  intrusion,  if  possible ;  ex- 
change thoughts  in  an  undertone,  and  out  of  the  sight  and  the 
hearing  of  eavesdroppers,  and,  if  possible,  never  let  your  con- 
versation be  overheard, — 

"The  very  shadows  seem  to  listen," — 

and  never  allow  any  one  to  be  present  except  the  physicians 
engaged  in  it.  When  the  consultation  ends,  the  attending 
physician  should,  of  course,  re-enter  the  sick-chamber  and  give 
all  the  directions,  etc.,  determined  upon  in  the  consultation. 

Bear  in  mind,  also,  that  consultations  are  called  for  the 
purpose  of  deciding  for  t\\e  future,  not  to  criticise  the  past;  how- 
ever, if  you  are  called  in  to  a  case,  and  find  that  the  attending 
physician  is  suffering  unmerited  odium  for  his  previous  treat- 
ment, every  principle  of  honor  should  impel  you  to  volunteer  to 
defend  him.  Beyond  this,  never  pass  any  opinion  on  the  plan 
of  treatment  in  hearing  of  the  patient  or  friends,  unless  it  be 
an  approbatory  one,  and  where  the  circumstances  truthfully 
admit  of  it. 

Let  all  that  follows  a  consultation  show  that  you  act  in 
concert  and  that  it  is  the  result  of  joint  action,  and  never  express 
an  individual  opinion  of  a  case  seen  in  consultation,  except  in 
strict  accordance  with  the  ethical  code.  If  you  do,  those  whom 
you  address  may,  either  unintentionally  or  purposely,  misinter- 
pret what  you  say,  or  otherwise  discreditably  involve  you. 

Remember,  moreover,  that  if  you  are  sufficiently  agreed  to 
continue  in  joint  attendance,  you  are  in  duty  bound  to  act  in 
concert,   uphold  each   other,   and  refrain   from    telling   whose 


HIS   REPUTATION   AND    SUCCESS.  221 

opinion  prevailed,  or  by  whom  the  course  pursued  was  suggested, 
and  from  all  other  hints  and  insinuations  likely  to  diminish 
confidence  in  your  fellow-attendant. 

'  If  for  any  reason  a  professional  friend  ever  request  you  to 
see  a  case  with  him,  not  so  much  for  the  patient's  welfare  as  on 
his  own  behalf,  ^^e.,  to  confirm  a  correct  diagnosis,  and  thus 
protect  him  against  undeserved  censure,  or  to  divide  unusual 
responsibility  toward  a  poor  or  worthless,  but  exacting  patient, 
or  to  advise  what  course  to  pursue  under  any  other  very  trying 
circumstances,  you  should  lend  him  a  ready  and  willing  hand, 
and  that,  too,  without  expectation  of  a  fee. 

"Hast  thou  no  friend  to  set  thy  mind  aright?  " 

It  would  be  sad,  indeed,  were  any  honorable  physician  to  fail  to 
find  at  least  one  medical  friend  to  consult  without  fee  in  such 
a  dilemma. 

Be  prompt  to  the  minute  in  answering  all  professional  cor- 
respondence. 

If  you  are  ever  requested  by  letter,  or  by  a  messenger,  to 
prescribe  for  an  out-of-town  patient  who  is  not  under  the  care 
of  any  other  physician,  it  is  perfectly  professional  to  do  so,  if  you 
wish,  even  though  you  may  never  have  seen  the  case ;  but, 
unless  the  case  is  a  clear  one,  it  might  not  be  judicious. 

Revere  the  past,  have  confidence  in  the  present,  and  hope 
for  the  future  of  our  glorious  profession,  and  strictly  avoid  dis- 
paraging the  individual  members  of  the  profession,  or  the  pro- 
fession itself,  or  telling  people  jokingly  of  the  mistakes  and 
discreditable  dilemmas  of  yourself  or  others ;  and  also  avoid 
decrying  and  ridiculing  medicine  to  the  laity,  and  boasting  of 
your  own  and  the  general  ignorance  of  disease  and  remedies,  and 
your  distrust  of  your  own  capacities,  or  of  the  number  of  people 
killed,  maimed,  mutilated,  or  destroyed  in  health,  and  suppress 
all  other  fulsome  confessions. 

"Evil  is  wrought  by  want  of  thought, 
As  well  as  want  of  heart." 

When  a  physician   makes  such  unguarded  and  sweeping 


222  THE   PHYSICIAN    HIMSELF: 

remarks,  he  means  them  relatively  only ;  he  means  to  say  that  he 
is  aware  and  willing  to  confess  that  medicine  has  its  natural 
limits,  and  is  not  an  exact  science,  and  that  the  application  of 
therapeutics  is  but  an  art.  The  public,  however,  cannot  appre- 
ciate the  sense  in  which  such  imprudent  confessions  are  made, 
and  they  are  taken  up  by  Doubting  Thomases  and  Lying  Pauls- 
as  quickly  as  a  sponge  takes  up  water,  and  work  no  little  harm 
to  pliysicians  who  make  them  and  to  the  profession  at  large ; 
because,  all  who  hear  or  read  them  conclude,  with  Tom  Hood, 
that  "  it  takes  a  great  many  M.D.s  to  be  worth  a  d — n,"  and 
that  our  prescriptions  are  only  a  series  of  guess-work,  and  that 
medical  practice  is  only  a  shapeless  mass  of  uncertainties,  con- 
tradictions, and  inconsistencies,  as  irregular  and  lawless  as  that 
of  the  winds;  whose  votaries  ask  whether  we  are  certain  of  any- 
thing, or  certain  that  we  are  certain  of  nothing ;  and  ever  after 
crack  jokes  at  our  expense, — 

"God  cures  and  the  doctors  charge," — 

and  either  do  not  employ  physicians  at  all,  or  do  so  with  feel- 
ings of  disrespect  and  distrust. 

You  know  there  is  no  such  thing  practically  as  a  perfectly 
straight  line,  plane  surface,  regular  curve,  exact  sphere,  or  uni- 
form solid ;  yet  you  never  hear  the  engineer  or  the  surveyor 
boasting  of  it  from  the  housetop,  or  in  reckless  language,  as  if 
to  belittle  his  own  profession.  Look  at  the  other  learned  pro- 
fessions: law  is  still  very  imperfect  and  full  of  uncertainties,  and 
it  has  its  reproaching  pettifoggers  just  as  we  have  our  quacks. 
Its  books  teem  with  conflicting  opinions,  and  the  best  decisions, 
of  to-day  are  liable  to  be  overthrown  by  others  of  to-morrow. 
Religion,  too,  has  its  opposing  creeds,  its  rival  spires,  and  its 
innumerable  sects,  and  its  ignorant  and  often  unprincipled 
expounders, — sad  proofs  that  Medicine  is  not  alone  imperfect. 

"All  things  are  big  with  jest  ;  nothing  that's  plain 
But  may  be  perverted  if  thou  hast  the  vein." 

The  truth  is,  physicians  personally  are  far  more  imperfect 
than  physic.     For    instance,  there  are  undoubtedly  medicines 


HIS   REPUTATION    AND    SUCCESS.  223 

the  action  of  which  is  diuretic ;  but  diuretics  may  be  given 
when  not  indicated,  or  the  diuretic  given  may  not  be  the 
proper  one,  or  it  may  be  given  in  improper  doses  or  at  wrong  in- 
tervals, or  it  may  not  be  continued  long  enougli,  "or  too  long,  or 
without  proper  restrictions.  Now,  none  of  these  errors  are 
justly  chargeable  to  the  class  of  medicines  which  we  call 
diuretics^  nor  to  the  art  of  medicine,  but  are  plainly  due  either 
to  the  physician's  bad  judgment  or  to  his  ignorance. 

"A  hand-saw  is  a  useful  thing,  but  not  to  shave  with." 

The  fact  is,  all  studious  physicians  are  more  or  less  conversant 
with  the  same  remedies,  but  skill  in  effecting  a  cure  with  them 
consists  in  applying  one's  knowledge  correctly,  in  thinking  of  and 
selecting  the  proper  ones,  skill  in  proportioning  the  dose,  and 
genius  in  judging  correctly  the  time  and  necessity  for  their  use, 
etc.  Just  as  different  persons  essaying  to  paint  will  exhibit  dif- 
ferent degrees  of  success:  one  possessed  of  natural  aptitude  or 
special  gift  will  obtain  wonderful  skill,  another  less  apt  will  reach 
mediocrity,  while  a  third  will  fail  entirely  in  his  attempts  and  quit 
in  disgust, — this  difference  in  result  being  due  not  to  a  differ- 
ence in  the  material  or  colors  at  the  command  of  each,  but  to 
the  more  or  less  perfect  judgment  and  skill  shown  by  each  in 
selecting  and  using  them.  There  must  be  a  reason  for  giving 
medicines  and  also  for  withholding  them,  and  there  must  be 
medication  in  sufficient  doses  when  there  is  an  indication  for  it. 

The  ability  to  determine  accurately  the  condition  of  a  pa- 
tient, and  to  conceive  and  do  the  right  thing  for  him  at  the 
right  time,  is  the  essence  of  skill,  constitutes  the  chief  difference 
between  successful  and  unsuccessful  physicians,  and  explains 
the  reason  why  the  prescriptions  of  some  physicians  are  much 
more  valuable  than  those  of  others.  One  may  know  a  vast  deal 
about  the  profession  and  yet  be  a  very  poor  practitioner. 

A  judicious  use  of  medicines,  and  not  a  wholesale  renun- 
ciation of  them,  is  a  leading  characteristic  of  a  good  physician. 
When  you  hear  of  a  physician  who  wishes  to  be  regarded  as 


224  THE   PHYSICIAN    HIMSELF: 

especially  clear,  or  ahead  of  others,  or  exceptionably.fair  in  his 
opinions,  boasting  that  he  is  skeptical,  "  does  not  believe  in 
drugs,"  "  depends  on  kitchen  physic,"  "on  nature,"  etc.,  you 
can  safely  conclude  that  he  has  a  very  weak  spot  somewhere ; 
either  that 

"He  has  mistook  his  calling," 

or  in  his  zeal  to  become  a  medical  philosopher,  or  to  coquette  with 
somebody  else's  opinion,  he  has  lapsed  in  his  materia  medica,  or 
overstates  his  credulity,  or  that  his  usefulness  has  run  to  seed. 

Does  the  mariner  lose  his  faith  in  navigation  because  ships 
are  tossed  by  the  winds  and  waves  and  too  often  wrecked  by 
uncontrollable  storms'?  Or  does  the  farmer  deny  the  fertility 
of  the  soil  because  his  neighbor  has  neglected  the  proper  season 
for  planting  and  the  right  mode  of  cultivation  ■?  Or  does  he 
lose  his  faitli  in  agriculture  because  droughts  and  insects,  and 
irregularities  of  sun,  rain,  and  frosts,  sometimes  ruin  his  crops  ? 
Would  any  worthy  sailor  fold  his  arms  and  do  nothing  while 
the  storm  raged,  or  any  thoughtful  farmer  neglect  to  plant  again 
when  the  season  returned,  because  the  sailor's  brightest  hopes 
are  sometimes  crushed  and  the  farmer's  fairest  prospects  are  often 
blighted]  Or  is  medicine  to  be  abandoned  because  in  some 
cases  it  is  unable  to  do  all  that  is  expected  of  it  ? 

"Medicine  is  God's  Second  Cause  of  Health." 

Is  there  a  physician  on  earth  who  would  let  intermittent 
and  remittent  fevers  take  their  course  without  drugs,  or  who 
would  let  the  syphilitic  and  other  poisons  develop  or  progress 
unchecked  1  Is  there  one  who,  in  the  face  of  the  positive  facts 
offered  by  anatomy,  and  physiology,  and  pathology,  and  chemis- 
try, and  hygiene,  and  materia  medica,  will  confess  that  he  can  do 
nothing  for  pain,  or  for  fever,  for  nervous  complaints,  for  digest- 
ive ailments  or  chest  diseases ;  nothing  for  diseases  of  the  circu- 
latory system,  delirium,  insomnia,  headache,  epilepsy,  hysteria, 
gout,  neuralgia,  worms,  colic,  acidity,  peritonitis,  child-bed  fever, 
constipation,  convulsions,  diarrhoea,  anaemia,  scurvy,  cholera 
morbus,  poisoning,  casualties,  etc.  ? 


HIS   REPUTATION   AND    SUCCESS.  225 

The  end  and  aim  of  medical  practice  being  to  relieve,  to 
cure,  and  to  prevent  death,  if  there  is  a  physician  in  the  land 
who  has  never  seen  medicines  restore  health  or  prolong  life,  and 
does  not  sincerely  believe  in  his  power  to  benefit  by  drugs  some 
of  the  twenty-four  hundred  diseases  and  modes  of  decay  to 
which  mankind  is  subject,  he  is  an  icy  infidel  in  medicine,  and 
should  at  once  and  forever,  for  conscience's  sake  and  for  the  sake 
of  the  afflicted,  take  down  his  sign,  burn  his  diploma,  drop  his 
title,  and  no  longer  pretend  to  practice.  What  think  you  of  a 
man  preaching  religion  and  living  by  the  pulpit  who  does  not 
believe  in  the  usefulness  of  religion  I 

"  Seem  a  saint  and  play  the  devil." 

The  tolerance  of  disease  has  greatly  increased  in  the  last 
few  decades,  and  is  still  increasing,  and  medical  theories  and 
practice  are  undergoing  great  changes.  The  advance  of  scien- 
tific observation  is  constantly  teaching  us  to  distinguish  more 
clearly  between  the  numerous  self-limited  cases  daily  met  with 
and  the  few  that  threaten  a  fatal  issue,  and  of  course  we  of 
to-day  use  much  simpler  remedies  for  the  former  class  than  did 
our  predecessors  ;  but  it  is  doubtful  whether  in  serious  illness 
we  have  lessened  the  doses  half  as  much  as  some  imagine.  We 
now  give  twelve  or  fifteen  grains  of  quinia  daily  for  an  inter- 
mittent fever,  where  physicians  formerly  gave  half  an  ounce  or 
an  ounce  of  crude  bark  containing  but  six  or  twelve  grains. 
We  give  to-day  the  same  dose  of  opium,  or  its  representative, 
morphia,  when  that  drug  is  indicated,  as  they  gave  a  hundred 
years  ago ;  the  same  quantity  of  castor-oil  at  a  dose,  and  so 
througliout  the  whole  materia  medica.  The  great  difference  is, 
that  we  do  not  now  prescribe  vaguely  or  rashly,  and  when  cases 
are  trifling,  or  obscure,  or  undeveloped,  our  treatment  is  tenta- 
tive instead  of  heroic. 

We  of  to-day  know  better  than  our  predecessors  the  natu- 
ral history  of  disease,  and  are  aware  of  the  almost  infinite 
resources  of  nature,  and  that  three  in  every  ten  of  those  who 


226  THE   PHYSICIAN    HIMSELF! 

send  for  physicians  need  no  positive  medication ;  that  recovery 
from  disease  is  everywhere  the  rule  and  death  the  exception ; 
and  that  nine  of  the  ten  vs^ould  get  well,  sooner  or  later,  by 
proper  hygiene,  air,  exercise,  dieting,  and  intelligent  nursing  if 
there  were  not  a  drug  or  a  physician  in  the  world,  and  conse- 
quently we  are  naturally  prescribing  less  and  less  medicine.  In 
acute  affections,  and  especially  the  cyclical  diseases  of  children, 
we  now,  in  many  cases,  mainly  trust  to  nature,  and  see  them 
get  well  spontaneously  from  seemingly  hopeless  conditions  almost 
as  if  by  magic,  and  these  cases  constitute  a  majority  of  those 
that  seem  to  be  restored  to  rosy  health  by  a  thousand  and  one 
therapeutical  illusions  and  quack  medicines  now  in  vogue. 

The  deduction  to  be  drawn  from  these  facts  is,  that  the 
prudent  physician  may  show  as  much — nay,  more — skill  in 
withholding  drugs,  and  especially  those  of  an  active,  perturbing 
character,  when  not  needed,  as  in  giving  them  when  they  are. 


CHAPTER  IX. 

"Pledged  to  no  party's  arbitrary  sway, 
Follow  Truth,  where'er  she  leads  the  way." 

Bear  in  mind  that  nothing  under  heaven  prevents  you  from 
giving  whatever  you  believe  to  be  best  for  your  patient,  whether 
its  therapeutic  action  be  similar,  antagonistic,  or  anything  else 
in  the  circle;  but  if,  in  so  doing,  you  adopt  a  narrow  or  foolisli 
dogma,  or  an  exclusive  system,  and  prejudice  your  mind  against 
all  other  ascertained  truths,  your  one-sided  partisanship  will 
fetter  you,  abridge  your  usefulness,  and  make  you  unfit  for 
fellowship  in  liberal  medicine.  Thus,  when  Vincent  Priessnitz, 
with  his  wet  sheets  and  water-tub,  in  trying  to  build  a  house  of 
a  single  brick,  shut  his  eyes  to  everything  but  hydropathy;  and 
one-sided  John  Brown  founded  Brunonianism  on  incitability ; 
and  Broussais  went  wild  on  Inflammation,  Gastro-enteritis,  the 
lancet,  and  leeches;  and  Rasori  overdosed  with  his  system  of 
"  Contraria  Contraries,"  and  rabidly  denounced  everything  else  ; 
and  Samuel  Thompson,  in  his  exclusivism,  threw  away  every- 
thing but  herbs,  they  each  ignored  a  host  of  important  facts 
for  jumbles  of  vain,  useless,  and  fanciful  speculations,  and  there- 
by lessened  their  own  usefulness  and  that  of  all  who  follow 
them, 

"Foi*  iievef  yet  liath  one  attained 
To  such  perfection,  but  that  time,  and  place, 
And  use  have  brought  addition  to  his  knowledge  ; 
^  Or  made  correction,  or  admonished  him 

That  he  was  ignorant  of  much  which  he 
Had  thought  he  knew,  or  led  him  to  reject 
What  he  had  once  esteemed  of  highest  price." 

Thus  it  is  with  agriculture,  and  navigation,  and  every  other 
human  occupation,  but  medical  science,  above  all  others,  has 
no  goal, — its  greatest  law  is  progress. 

Medicine  is  neither  a  perfect  nor  a  stationary  science ;  not 
a  single  department  of  medicine  has  yet  reached  scientific  exact- 

(227) 


228  THE    PHYSICIAN    HIMSELF  I 

ness,  and  possibly  never  will.  We,  as  rational,  unrestricted  phy- 
sicians, absolutely  free  to  think  and  free  to  act,  are  striving  hard 
to  bring  its  various  branches  as  near  to  perfection  as  possible, 
and  are  willing  to  learn  medical  truth  and  scientific  wisdom 
wherever  they  can  be  found,  and  there  is  to-day  nothing  of  any 
value  in  any  exclusive  system  that  is  not  taught  by  the  teachers 
of  the  regular  profession. 

"  And  thus  we  are  the  true  Eclectics." 

When  "  New  Schools,"  schisms,  or  creeds  arise,  if  they 
possess  any  new  or  valuable  truths,  or  remedies  of  ascertained 
merit,  no  matter  how  great  or  how  small,  whether  taken  from 
the  animal,  vegetable,  or  mineral  kingdom ;  from  sponge,  weed, 
insect,  or  mineral ;  product  of  wilderness,  ocean,  or  prairie,  we 
instantly  single  them  out  and  incorporate  them  with  the  great 
mass,  to  swell  the  records  of  rational  medicine,  and  press  on- 
ward; so  that  the  medicine  of  to-day  may  be  said  to  be  a  living, 
moving,  growing  array,  founded  on  all  its  yesterdays. 

Irregulars  of  every  kind  feel  that,  to  exist,  they  must  be  at 
war  with  the  regular  profession,  and  derisively  style  us  "  The 
Old  School,"  "  Allopaths,"  etc.,  to  make  it  appear  to  their  par- 
tisans that  a  creed  is  necessary,  and  that  every  physician  must 
bear  the  trade-mark  of  some  restricted  school  or  petty  sect,  with 
wide-apart  principles;  and  that  we  are  merely  one  of  these 
restricted  sects,  with  hoary  dogmas,  and  an  old-fashioned  and 
dilapidated,  moss-grown,  ivy-covered  creed,  twenty-four  centuries 
old.     That, 

"Slaves  to  rnsty  rules," 

we  have  by-gone  habits,  ancient  ways  of  thinking,  and  set  rules 
and  doctrines,  which,  though  good  enough  in  olden  days,  are 
now  altogether  inadequate  and  behind  the  times,  and  in  their 
declension.  Their  aim  in  doing  this  is,  of  course,  to  draw  un- 
restricted physicians  on  to  ililse  ground  before  the  public,  and 
to  obtain  for  their  own  ism  or  patliy  the  honorable  distinction  and 
the  business  advantage  of  appearing  to  stand  co-equal  with  us ; 
just  as  in  religion  one  sect  (Pharisees  versus  Sadducees,  or 


HIS   REPUTATION   AND    SUCCESS.  229 

Catholics  versus  Protestants)  stands  with  reference  to  another, 
and  in  politics  Republicans  stand  with  Democrats. 

Faugh  on  such  nonsense  !  Who  are  the  heroes  of  modern 
medical  science  %  What  men  are  to-day,  as  ever,  bearing  for- 
ward the  flag  of  medical  discovery,  and  making  the  star  of  truth 
shine  over  the  hill-tops  of  medical  discovery  as  clear  as  the  noon- 
day sun  %  Regular,  unrestricted  physicians  !  Who  are  the  great 
authorities,  and  who  hold  the  most  advanced  views  on  anatomy, 
physiology,  pathology,  gynaecology,  ophthalmology,  insanity, 
bacteriology,  etc.  %  None  other  than  regular  physicians  !  Where 
stand  quacks  and  irregulars  of  every  kind  in  the  upward  track 
of  scientific  medical  progress "?  What  have  they  done  for 
science'?     o  o  o  0 nothing! 

Remember,  that  it  is  not  on  account  of  their  therapeutics 
at  all  that  we  object  to  exclusive  systems  and  refuse  to  fraternize 
with  their  followers,  but  because  they  deny  the  usefulness  of 
remedies  taken  from  any  source  but  theirs ;  assume  dogmas  and 
systems  that  are  limited,  and  decry  and  denounce  all  else. 

Were  you  to  announce  yourself  as  an  anti-botanic,  anti- 
omnipathist,  anti-allopathist,  anti-eclectic,  anti-electropath,  anti- 
hydropath,  anti-vitopath,  or  anti-any thing  else  calculated  to  pro- 
duce division,  antagonism,  or  strife  in  the  ranks,  it  would  be 
unprofessional,  and  equally  as  inconsistent  with  the  spirit  of 
scientific  medicine  as  the  systems  you  were  opposing,  and  would 
abridge  your  usefulness  and  render  you  unworthy  of  professional 
fellowship,  just  as  it  does  others  who  follow  opposing  creeds. 

Although  it  is  wrong  to  spend  much  time  and  labor  in  ac- 
quiring knowledge  of  anything  that  is  useless  when  known,  yet 
it  is  well  to  look  into  the  principles  of  mesmerism,  hydropathy, 
galvano-therapeutics,  hypnotism,  spiritualism,  etc.,  to  enable  you 
to  speak  of  them  from  personal  knowledge,  and  to  checkmate 
their  representatives,  who,  in  their  arguments  to  the  laity,  make 
great  capital  out  of  hnoioing  all  about  the  "  old-school  s/jstem,'"' 
which  they,  of  course,  aver  does  not  compare  with  whatever 
"  new  school "  they  practice. 


230  THE    PUYSICIAN    HIMSELF: 

To  limit  one's  practice  to  any  certain  segment  of  the  medi- 
cal circle  is,  of  course,  quite  different  from  limiting  one's  creed. 
You  have  an  indisputable  right  to  confine  yourself  to  any 
specialty  or  department  of  medicine  you  please,  but  as  it  is  a 
self-imposed  limitation  of  your  sphere  you  should  take  care  in 
your  signs  and  cards  simply  to  add  to  your  general  title  the 
words  "Practice  limited"  to  the  eye,  or  to  the  throat,  or  to  skin 
diseases,  or  to  whatever  else  your  specialty  may  be.  Such  an 
announcement  is  honest  and  professional,  and  claims  nothing- 
more  in  the  way  of  skill  than  your  M.D.  presumes.  A  sign  or 
card  with  the  words  "Practice  limited  to,"  etc.,  is  perfectly  pro- 
fessional; one  that  reads  "Special  attention  given  to,"  etc.,  is 
not. 

Bear  in  mind  that  we  condemn  no  system  or  discovery, 
io-norantly,  on  the  principle  which  governs  the  Indian,  who  dis- 
believes in  the  locomotive  and  telegraph,  or  on  that  by  which 
Galileo  was  persecuted,  which,  by  the  way,  was  theological,  not 
scientific ;  neither  do  we  accept  anything  as  a  blinded  Hindoo 
devotee  does  his  religion;  but,  on  the  contrary,  thousands  of 
competent,  earnest,  fair-minded,  truth-loving  deep-thinkers  and 
clear-seers  all  the  world  over,  both  in  hospital  and  private  prac- 
tice, with  open  eyes  and  alert  ears,  solely  for  the  purpose  of 
ascertaining  the  truth  for  the  benefit  of  medical  science  and  of 
suffering  mankind,  and  anxious  to  see  new  links  added  to  the 
great  chain  of  therapeutic  aids,  eagerly,  and  fairly,  and  deliber- 
ately investigate  and  test  all  the  alleged  important  discoveries, 
plausible  theories,  and  so-called  reforms  in  medicine  fi'om  A  to 
Z  when  they  arise,  and  by  the  conjoined  result  from  a  thousand 
sick-rooms  and  laboratories  give  a  true  common-sense  verdict. 

"  When  free  from  folly,  we  to  wisdom  rise." 

And  it  is  no  more  necessary  for  every  succeeding  generation, 
with  more  useful  things  to  think  about,  to  turn  aside  and  dis- 
cuss whether  cholera  first  appeared  at  Jessore  or  in  Bengal,  or 
whether  iEsculapius  was  a  real  person  or  only  a  myth,  or  to 
re-sift,  re-weigh,  and  re-judge  unreasonable  medical  vagaries  and 


HIS   REPUTATION    AND    SUCCESS.  231 

nonsensical  dogmas  that  have  been  a  hundred  times  disproved 
before  rejecting-  them,  than  it  is  for  every  one  to  study  spirit- 
rappings,  jingoism,  table-turning,  the  Book  of  Mormon,  and 
the  ins  and  outs  of  all  other  freaks,  frauds,  frenzies,  jackassical 
doctrines,  therapeutic  follies,  and  theoretical  crazes,  after  thouands 
and  tens  of  thousands  have  proven  them  false. 

One  of  the  most  amazing  of  all  wonders  is  that  wisdom  in 
the  mysteries  of  the  law  or  in  the  doctrines  of  theology,  acumen 
in  the  sciences,  skill  in  the  polished  arts,  or  keenness  and  cul- 
ture in  other  departments  of  human  knowledge,  scarcely  in- 
creases some  people's  reasoning  powers  a  jot  above  the  Ancient 
Egyptians  in  medical  matters,  or  prevents  their  being  led  astray 
by  false  notions  of  cures,  remedies,  specifics,  and  antidotes. 

More  than  one  prominent  citizen  continues  to  put  knotted 
red  strings  around  children's  necks  to  cure  whooping-cough,  or 
a  bag  of  camphor  or  of  asafoetida  to  ward  off  the  epidemic; 
more  than  one  sea-captain  carries  a  potato  or  a  "chunk"  of 
brimstone  in  his  pocket,  or  wears  one  stocking  wrong  side  out, 
to  charm  away  rheumatism;  more  than  one  millionaire  has 
vowed  that  globules  of  tartar  emetic  have  restored  his  strength ; 
and  such  is  poor  human  nature,  that  many  a  victim  is  actually 
ready  solemnly  to  certify  that  this,  that,  or  the  other  worthless 
quack  swindle  has  saved  his  life,  yea,  even  after  he  had  stood  on 
the  crater  of  the  volcano  of  death  and  heard  the  rustling  of  the 
black  angel's  wings. 

"Heuce,  Sharper,  pitch  thy  trammel  where  thou  please, 
Thou  canst  not  fail  to  catch  such  fish  as  these." 

How  any  individual  can  be  a  wise  logician  in  all  else,  and 
yet,  as  soon  as  sickness  attacks  him  or  his,  leave  all  reason  be- 
hind, and  with  open  mouth  and  closed  eyes  become  an  easy, 
almost  voluntary  prey  to  shallow  quackery,  and  exhibit  the 
strongest  faith  in  sophistical  pretension  whose  assumptions  are 
glaringly  contrary  to  common  sense,  is  a  psychical  enigma  that 
almost  weakens  one's  faith  in  the  common  sense  of  half  of  man- 
kind. 


232  THE   PHYSICIAN    HIMSELF: 

Never  hold  joint  discussions  or  controversies  before  the  non- 
professional piibHc,  with  Irregulars,  noisy  quacks,  or  wrong- 
headed  enthusiasts,  either  through  the  newspapers  or  in  any- 
other  way,  no  matter  how  false  or  shallow  their  doctrines  or  oily 
pretenses  are,  or  how  easily  their  weak  arguments  are  refuted 
by  stronger  ones;  because  such  joint  discussions  and  rejoinders, 
either  by  speech  or  pen,  with  the  public  as  judge,  would  result 
in  no  good,  but  give  PoUywantsacracker  &  Co.  an  opportunity 
to  make  the  noise  and  clamor  they  desire,  bring  them  into 
greater  notice,  gain  for  them  new  partisans,  and  give  them  a 
chance  to  cloud  the  truth,  raise  additional  false  issues,  and  pose 
as  martyrs  to  scientific  persecution. 

You  will  occasionally  be  called  again  to  families  who,  on 
account  of  the  blunder  or  misconduct  of  some  unlucky  or  in- 
competent member  of  the  profession,  strayed  in  disgust  from 
regular  medicine  years  ago,  when  bleeding,  etc.,  were  fashion- 
able, who  will  be  surprised  to  learn  that  the  fashion  of  medical 
practice  has  changed,  and  that  your  therapeutics  differ  very 
decidedly  from  those  of  Professor  Oldkind  and  Doctor  Van 
Winkle,  and  that  you  have  learned  to  unlearn  many  things  and 
have  not  taken  an  oath  to  practice  as  our  great-grandfathers 
did,  and  no  longer  bleed,  salivate,  and  give  nauseous  drugs 
indiscriminately.  If  you  are  prudent  and  circumspect,  most  of 
these  can  be  permanently  reclaimed. 

"Then,  grasp  the  skirts  of  happy  chance." 

But  few  of  the  really  sick  who  are  persuaded  into  giving 
false  and  one-idea  systems  a  '  trial  become  converts ;  common 
sense  prevents.  Therefore  be  careful  not  to  banter,  irritate,  or 
abandon  people  who  are  trying  an  ism  or  a  ])athy^  or  believe  in 
it  a  little,  lest  from  combating  their  maybes,  questioning  their 
prudence,  and  forcing  argument,  you  drive  them  into  these 
vagaries  permanently.  Should  one  even  contend  that  the  earth 
is  three-cornered,  or  that  sugary  nonsense  has  saved  his  life,  or 
that  pumpkins  grow  on  trees,  or  declare  white  to  be  black,  or 
that  castor-oil  is  made  of  dead   men's  bones,  or  that  a  horse- 


HIS   REPUTATION    AND    SUCCESS.  233 

chestnut  and  a  chestnut  horse  are  one  and  the  same  thing:,  laus-h 
in  your  sleeve  if  you  must,  but  do  not  combat  him  too  fiercely^ 
lor  pride  of  opinion  and  determination  not  to  be  browbeaten 
into  recantation  are  unfortunate  impulses  to  arouse,  especially 
in  conceited  and  silly  people,  who  admire  their  own  ingenuity 
in  discovering  arguments,  and  will  certainly  drive  them  to  take 
sides  against  you  with  energy  and  zeal,  possibly  to  swear  by  the 
error  in  all  the  moods  and  tenses,  and  thenceforth  to  injure 
rational  medicine  to  the  full  extent  of  their  influence  ;  for, 

"Faith,  fanatic  faith,  once  wedded  fast 
To  some  dear  falsehood,  hugs  it  to  the  last." 

If,  in  exposing  any  delusive  or  false  system,  you  are  careful 
not  to  denounce  it  with  too  much  warmth,  as  though  prompted 
by  prejudice  or  self-interest,  and  confine  your  condemnation 
strictly  to  the  impersonal  abstract  subject,  showing  that  you 
speak  your  real  sentiments  from  sober  reason  and  conscientious 
devotion  to  the  truth ;  and  if,  moreover,  you  avoid  appearing 
anxious  to  hoot  down  or  excite  hostility  against  the  individuals 
who  appear  to  practice  it  honestly,  your  reasoning  will  have  a 
great  deal  more  weight  with  those  whom  you  address,  and  witli 
the  community,  than  under  the  reverse  circumstances  ;  for  human 
nature  is  such  that,  if  a  system  or  creed  in  medicine  be  false, 
unkind  or  untrue  abuse  of  its  representatives  will  be  one  of  the 
best  ways  of  commending  it  to  public  favor,  and,  therefore,  is 
vs^hat  they  themselves  most  heartily  desire. 

Ours  is  the  age  of  quackery, — quackery  in  law,  quackery 
in  religion,  quackery  in  medicine,  quackery  in  everything.  Med- 
ical quackery  subsists  on  credulity,  gullibility,  and  ignorance, 
and,  whenever  you  have  a  fair  opportunity,  it  is  your  duty  to 
expose  it,  and  to  save  as  many  as  you  can  from  its  clutches. 

Medical  laws  that  discriminate  in  favor  of  the  true  men  of 
science  and  integrity,  and  against  the  empiric  and  impostor, 
are  everywhere  essential  to  the  public  health  and  the  public 
safety ;  but  many  of  our  States  have  no  medical  laws  at  all, 
and   their  common  laws  do  not  protect  their  citizens  as^ainst 


234:  THE    PHYSICIAN    HIMSELF: 

imposition  or  enter  into  the  slightest  consideration  of  the 
worth,  or  worthlessness,  of  various  isms,  isfs,  and  2:>atliies^  but 
recognize  all  kinds,  regular,  irregular,  and  mongrel,  even  down 
to  notorious  quacks  and  ignoble  impostors,  who  never  saw- 
farther  into  the  human  body  than  the  skin,  precisely  as  they  do 
the  regular  profession ;  therefore,  if  you  ever  occupy  an  official 
position  under  such  laws,  you  will  have  to  recognize  certificates 
of  death,  vaccination,  life-insurance,  etc.,  given  by  irregulars  of 
every  shade,  no  matter  how  fictitious  their  pretensions,  or  how 
profoundly  ignorant  of  common  medical  truths,  just  as  you  do 
those  of  intelligent,  rational,  honorable  physicians.  In  a  word, 
you  will  have  to  recognize  officially  every  person  whom  the  law 
recognizes.  State  medical  laws  that  indiscriminately  legalize 
people  of  all  kinds,  of  all  colors,  of  both  sexes,  and  of  all 
nations,  or  give  a  license  to  practice  to  every  ignoramus,  are 
impaired  to  a  corresponding  extent.  What  we  need  is  proper 
laws  for  the  protection  of  the  people, — laws  that,  while  recog- 
nizing and  protecting  the  rights  of  all  educated  physicians,  with- 
out regard  to  their  creeds  or  modes  of  treatment,  would  unspar- 
ingly uproot  and  weed  out  the  whole  miscellaneous  rabble  of 
abortionists,  self-commissioned  faith-cure  pretenders,  oxygen 
quacks,  the  Street-corner  Doctor, — 

"From  his  discourse  he  should  eat  nothing  hut  hay," — 

Ambulating  Electric  Itinerants,  Indian  Doctors  with  their 
wongnim  and  bunyip,  Steam  Doctors,  Pow-wow — 

"  Every  inch  that  is  not  fool  is  rogue  " — 

and  Root  Doctors,  with  their  "  passel  of  yerbs,"  who  neither 
read  nor  write,  but  get  their  "tolerabl'  sartin  "  larning  about 
RUTES  AND  YERBS,  "  by  revelation  from  the  Lawd  " ;  also  Dr. 
Squish,  the  "  cullud  gemman "  who  learned  to  cure  the  con- 
jured "  by  'speriments," — 

"Just  hefo'  de  wah," — 

and  other  mean  and  soulless  swindlers  who  know  as  little  about 
a  physician's  duties  as  they  do  about  a  geometrical  icosahedron 


HIS    REPUTATION   AND    SUCCESS.  235 

or  the  constellations  of  the  heavens,  but  pretend  to  answer  the 
unanswerable,  and  make  lying  promises  to  cure  the  mcurable ; 
and  all  other  outlaws  who  knowingly  deceive  and  defraud. 

"Expunge  the  whole." 

Just  laws  requiring  written  examinations  upon  the  funda- 
mentals of  Anatomy,  Physiology,  Chemistry,  Surgery,  Practice 
of  Medicine,  Materia  Medica,  Therapeutics,  Obstetrics,  Gynae- 
cology, Pathology,  Medical  Jurisprudence,  and  Hygiene,  should 
be  enacted  and  rigidly  enforced  in  every  State,  instead  of  weak 
laws  that  confound  the  worthy  and  the  worthless,  the  skillful 
and  the  useless,  the  educated  and  the  ignorant ;  and  not  only 
compel  those  who  administer  them  to  recognize  fool-quacks, 
illiterate  boobies,  consummate  dunces,  and  a  whole  troop  of 
*'  nat'ral "  born,  darn'd  fools,  but  also  lend  respectability  before 
the  public  to  knave-quacks  who  deserve  the  cat-o'-nine-tails. 

But  when  you  see  that  blessed  day, 
Then  order  your  ascension  robe." 

Mixed  examining  boards  are  objectionable ;  better  to  have 
separate  boards,  each  consisting  of  seven  members,  the  Board 
of  Regular  Physicians  to  examine  all  who  wish  a  license  to 
practice  Regular  Medicine  in  the  State,  the  Eclectic,  Homoe- 
opathic, and  other  boards  to  do  the  same  for  theirs,  as  in  the 
present  medical  law  of  Maryland. 

It  would  be  well  and  wise  if  all  medical  diplomas  and  offi- 
cial certificates  were  written  in  plain  English,  instead  of  Latin  ; 
then  everybody  could  read  and  see  what  each  was,  and  when, 
why,  where,  and  to  whom  each  was  given. 

Strange  to  say,  nowadays  a  section  of  the  public,  blinded 
by  the  waves  of  sophistry  and  swayed  by  the  winds  of  false  sen- 
timent, instead  of  siding  with  our  opponents  when  they  seem  to 
be  right  and  turning  against  them  when  they  seem  wrong,  invari- 
ably Ha !  Ha !  Ha !  and,  with  gross  unfairness,  side  with  the 
*'new  school"  or  the  quack,  or  anybody  else,  whenever  a  con- 
test arises  between  them  and  us. 

"Truth  forever  on  the  scaffold, 
Wrouii;  forever  on  the  throne.  " 


236  THE    PHYSICIAN    HIMSELF: 

Even  the  press  seems  to  delight  in  aiming  shafts  at  the  regular 
profession  and  creating  popular  sentiment  in  favor  of  our  ene- 
mies, by  making  invidious  comparisons  between  their  modes  of 
j)ractice  and  ours,  telling  of  their  wonderful  success  and  steady- 
growth  in  public  confidence  in  highly  colored  terms.  Censori- 
ous editorials  and  lampoons  are  frequently  written  on  our  arbi- 
trary exclusiveness,  our  bigotry,  etc. ;  our  bickerings  and  our 
disagreements,  too,  are  magnified,  and  our  professional  squab- 
bles and  disputations  are  reported  in  a  sensational  way,  all 
apparently  to  antagonize  and  decry  us  and  to  cheer  on  and 
assist  the  onsets  of  struggling  Irregulars  and  advertising  quacks, 
under  their  false  but  popular  cry  of  "  persecution." 

You  will  find  that  if  a  person  happens  to  get  better,  even 
of  an  ordinary  affection,  under  the  chance  play  of  an  Irregular,  or 
by  fool's  luck  when  taking  a  quack  medicine,  it  attracts  general 
attention  and  every  one  will  speak  of  it;  whereas,  if  twenty, 
equally  important,  get  well  under  the  skillful  practice  of 
regular  physicians,  it  is  considered  quite  a  matter  of  course,  and 
scarcely  excites  a  comment. 

'Tis  said  the  Chinese  are  so  expert  in  making  much  out  of 
little  that  they  live  and  fatten  on  what  a  Caucasian  wastes.  In 
the  same  degree,  Irregulars  and  quacks  thrive  on  the  quicken- 
ing influence  of  the  emotions — expectation,  faith,  hope,  etc. — 
which  we,  with  our  minds  fixed  on  more  tangible  agents,  neglect 
far  more  than  we  should.  For  proof  of  the  mighty  power  of 
the  mind  over  the  body,  look  at  the  liver-pads,  tractors,  amulets, 
•charms,  and  dozens  of  other  humbug  agents  now  in  vogue, 
which  the  young  and  old,  black  and  white,  educated  and  illiter- 
ate, all  kinds,  classes,  and  conditions  of  people,  are  praising, 
almost  as  if  they  had  fallen  from  the  skies. 

Fashion  and  wealth  exert  a  powerful  influence  in  medical 
affairs,  and,  unfortunately,  the  novelty-seeking  portion  of  the 
fashionable,  wealthy,  and  influential  foster  with  their  influence 
and  patronize  with  their  wealth  almost  every  pathy,  ology,  and 
ism  in  medicine,  and  make  them  popular  and  fashionable,  while 


HIS    REPUTATION    AND    SUCCESS.  237 

some  of  the  lower  strata  stand  with  eyes,  ears,  and  mouth  all 
open,  ready  to  follow  every  fashionable  foible. 

Some  Irregulars  have  this  source  of  eclat.  Having  the 
humbug  element  fully  developed  in  them,  they,  with  a  look  of 
owlish  wisdom,  big  words,  and  a  jargon  of  technical  terms, 
magnify  what  we  would  call  a  slight  cold,  or  a  quinsy,  into  a 
*'  congestion  of  the  lungs,"  a  "  bronchial  catarrh,"  a  ''  touch  of 
pneumonia,"  "diphtheria,"  or  "post-nasal  catarrh";  dignify 
what  we  would  call  a  disordered  stomach  into  a  "  gastric  affec- 
tion," a  wind  colic  into  "  borborygmus,"  a  wen  into  a  "  cancer," 
etc.,  for  the  cure  of  which  hard-named  diseases  they  are  duly 
credited  in  their  statistics  and  fully  paid  by  their  patients,  who 
are  thus  added  to  the  list  of  "  saved,"  and  the  family  are  fully 
convinced  of  that  ism's  or  pathy's  remarkable  power  in  those  dis- 
eases. There  is  a  fellow  in  our  section  who  works  this  trick  so 
adroitly  that  he  actually  reaps  more  credit  and  confidence  from 
mistreating  a  case  that  dies  therefrom  than  you  would  receive 
from  one  properly  treated  that  gets  well,  and  reaps  more  credit 
and  patronage  for  stopping  a  chill  and  fever  in  seven  days  than 
an  honest  physician  would  for  doing  the  same  in  a  day  or  two. 

Another  reason  why  Irregulars  get  cases  is,  that  if  a  phy- 
sician grows  tired  of  a  case  and  loses  interest,  or  the  patient 
gets  tired  of  him  and  loses  faith,  the  family  is  apt  to  desire  a 
change  of  treatment,  and,  fearing  the  attendant  would  become 
offended  were  they  to  dismiss  him  and  employ  one  of  his  breth- 
ren, they  get  an  Irregular,  under  the  belief  that  the  physician 
will  feel  less  hurt  if  they  dismiss  him  under  the  plea  of  trying 
"  a  different  system  "  of  doctoring  than  on  any  other  pretext. 
Besides :  there  are  fully  five  times  as  many  regular  physicians  as 
there  are  irregulars,  and  we  naturally  get  more  stubborn  cases, 
and  more  dissatisfied  patients,  who  turn  from  our  larger  number 
to  them,  to  "try  another  system,"  than  there  are  to  come  from 
their  smaller  number  to  us.  We  suffer  more  because  we  have 
more  to  lose. 

Irregulars  have  thus  been   catching  numbers  of  patients 


238  THE    PHYSICIAN    HIMSELF: 

under  the  idea  that  they  are  "  speciaUsts  in  therapeutics."  The 
advent  of  our  true  speciaUsts  is  very  fortunate  for  us  in  this 
respect,  as  more  and  more  of  our  stubborn  cases  now  fall  into 
their  hands  instead  of  wandering  off,  and  are  thereby  kept  with 
the  regular  profession. 

"  For  this  relief,  much  thanks." 

Again,  a  physician  is  sometimes  compelled  to  tell  disagree- 
able truths,  and  candidly  to  give  a  gloomy  or  despairing  prog- 
nosis, and  this,  on  the  principle  of  a  drowning  man  catching  at 
a  straw,  is  apt  to  make  the  patient  and  his  friends  argue  that,  as 
regular  medicine  offers  him  no  guarantee  of  safety,  they  had 
better  transfer  the  case  to  some  irregular  practitioner,  or  to  a 
noisy  quack,  who  makes  great  professions  and  rosy  promises. 

Another  reason  why  Irregulars  have  partisans  is,  that 
legitimate  medicine  is  unsuited  to  the  peculiarities  of  some 
minds,  and  will  never  obtain  their  confidence.  Some  would 
almost  rather  die  under  the  hands  of  an  irregular  than  to 
recover  under  a  regular.  There  is,  also,  always  a  sprinkling 
of  extremists  and  pharisees,  long-haired  men  and  short-haired 
women,  of  every  conceivable  type  of  mind, — 

"Nature  in  her  time  has  framed  strange  bedfellows," — 

opponents  of  vaccination.  Spiritualists,  and  other  well-known 
malcontents  in  every  community,  who  for  one  cause  or  other 
are  imbued  with  dogged  antagonism  to  the  regular  profession, 
and  the  fellow  who  discards  it  is  their  doctor ;  others  believe  in 
vegetable  remedies  only ;  the  prescriber  of  herbs  is  their  doctor,, 
etc.  All  such  unite,  by  affinity,  to  abet  and  support  classes  and 
systems  that  practice  in  opposition  to  us,  and,  of  course,  such 
demand  creates  a  supply. 

You  will  find  that  not  only  in  medicine,  but  on  every 
important  subject,  when  the  plain,  common  sense  of  a  commu- 
nity reaches  a  conclusion,  there  are  always  persons  who  think 
they  exhibit  finer  qualities  of  mind  by  reaching  the  opposite 
conclusion,  and  will  contend  bitterly  on  points  where  rational 
doubt   is   impossible.       Other   "  intelhgent   enemies  "   think   it. 


HIS   REPUTATION    AND    SUCCESS.  239 

evinces  great  natural  acuteness  and  subtlety  of  intellect  to  cling 
to  the  opposition,  and  imagine  they  thus  show  superior  penetra- 
tion and  sapiency. 

Still  another  reason  why  Irregulars  get  patrons  is  this : 
they  all  take  care  to  announce  that  WE  cure  by  mild  means  or 
harmless  methods,  and  not  by  complicated,  painful,  or  danger- 
ous measures,  bloody  operations  under  anaesthetics,  or  other 
dernier  ressorts  that  science  teaches  truer  physicians  to  use — 
against  all  of  which  they  have,  by  false  assertions  and  fallacious 
statistics,  aroused  much  of  the  existing  prejudice  and  abhorrence. 

"  Fear  has  big  eyes." 

So  great,  indeed,  is  the  popular  dread  of  what  physicians 
might  do,  that  in  choosing  a  medical  attendant,  tlie  nervous  and 
the  timid,  the  friables  and  the  feebles,  who  constitute  nine-tenths 
of  all  the  sick,  are  greatly  inclined  to  shun  Prof.  Sawbones,  Dr. 
Doubledose,  Dr.  Drastic,  Dr.  Cutemupalive  (with  liis  ostenta- 
tious preparations  and  formidable  array  of  instruments),  Dr.  Big- 
pill,  Dr.  Caustic,  and  all  who  treat  heroically  and  enforce  rigid 
discipline,  and  to  seek  Prof.  Tweedlum,  Drs.  Golightly,  Lamb- 
like, and  Silky,  who  undertake  to  cure  without  cutting,  and 
who  use  moderate  or  pleasanter,  even  though  less  efficient, 
means. 

The  rational  treatment  of  disease  varies  from  expectant  to 
heroic,  according  to  the  exigencies  of  each  case,  and  you  must 
learn  to  distinguish  cases  in  which  you  can  safely  depend  on 
nature  from  those  that  nature  cannot  combat,  and  treat  each 
accordingly ;  for  when  you  learn  to  recognize  those  who  need 
an  ounce  of  medicine  and  a  grain  of  policy  from  those  who 
need  an  ounce  of  policy  and  but  a  grain  of  medicine,  you  will 
have  entered  upon  one  of  the  paths  of  wisdom,  and  will  make 
yourself  and  your  profession  more  useful  and  more  acceptable. 
When  you  have  a  Lah-de-Dah  patient,  with  taste  or  imagina- 
tion unusually  developed,  who  needs  little  or  nothing,  for 
mercy's  sake  don't  violate  common  sense  and  force  upon  him 
some  horrible  mixture  that  seems  as  if  made  of  dead  men's 


240  THE    PHYSICIAN    HIMSELF: 

skulls,  or  a  bitter  infusion,  or  a  large  bottle  of  muriated.  tincture 
of  iron  and  quinine,  or  other  medley  of  nastiness,  as  if  your 
chief  aim  were  to  cause  nausea  and  disgust.  Give  no  one  any- 
thing stronger  or  coarser  than  he  actually  needs,  and  leave  the 
balance  to  nature. 

Also,  handle  all  who  have  highly  impressible  nervous  sys- 
tems, or  sensitive  skin,  delicate  palates,  tender  throats  or  treacher- 
ous stomachs  (and  wry  faces),  so  to  speak,  with  kid  gloves,  and 
be  careful  to  avoid  all  useless  severities,  and  to  give  them  as 
little  unpleasant-tasting  medicine  as  possible,  and  never  more 
than  they  can  bear.  The  recent  great  improvements  in  the 
forms  and  palatability  of  medicines,  in  addition  to  your  own 
knowledge  of  the  elegant,  offer  you  splendid  opportunities  to 
do  this.  Keep  clear  of  their  prejudices,  and  offend  neither 
their  eyes,  their  ears,  their  nostrils,  their  palates,  nor  their  stom- 
achs, and  you  will  succeed  where  neglect  of  these  precautions 
might  cause  failure.  Also,  bear  constantly  in  mind  that  pain- 
ful operations  that  fail,  or  disagreeable  medicines  used  unsuc- 
cessfully, if  they  have  given  pain  or  great  niconvenience,  will 
injure  your  reputation  and  may  even  cause  your  dismissal. 
Give  hypochondriacs,  dyspeptics,  and  other  Pooo-oo-oo-oo-r 
Cre-e-eatures  who  are  fond  of  attention,  but  not  of  medicine, 
small,  tasteless,  or  palatable  remedies,  and,  unless  there  is  a  real 
necessity  for  it,  do  not  oblige  anybody  to  take  medicine  before 
breakfast,  or  to  be  aroused  for  that  purpose  during  the  night. 
With  such  people  make  free  use  of  bland  elixirs,  the  fluid 
extracts,  sugar-coated  granules,  pepsins,  emulsions,  troches, 
lozenges,  capsules,  and  other  results  of  artistic  elegance  and 
chemical  accuracy  now  kept  in  every  drug-store. 

Overdosing,  blood-letting,  salivating,  purging,  etc.,  are  now 
justly  unpopular,  and  ultra-conservative,  reconstructive  medi- 
cines are  in  vogue.  iVlmost  every  one  is  filled  with  the  belief 
that  he  is  debilitated.  Say  to  the  average  patient,  "  You  are 
weak,  '  below  par,'  and  need  building  up,"  and  you  will  at  on-ce 
see  bv  his  countenance  that  you  have  struck  Ids  key-note.     So 


HIS   REPUTATION    AND    SUCCESS.  241 

much  is  this  the  case  that  many  of  the  ailing,  strongly  impressed 
with  this  idea,  will  want  you  to  treat  them  with  tonics  and 
stimulants,  even  when  their  condition  is  such  that  these  medi- 
cines are  contra-indicated. 

Never  attempt  to  force  the  use  of  a  remedy — mercury, 
arsenic,  iodide  of  potassium,  opium,  asafoetida,  valerian,  etc. — 
on  a  person  after  he  has  exhibited  an  idiosyncrasy  or  a  hatred 
toward  it.  Also,  when  possible,  change  the  form  of  your  pre- 
scription from  pills  to  powders,  or  from  liquids  to  capsules,  or 
from  sweet  to  bitter,  and  vice  versa,  for  those  who  desire  it. 

A  good  plan  to  pursue  with  patients  who  actually  need  the 
prolonged  benefit  of  two  different  medicines,  who  can  not  or  will 
not  take  them  at  alternating  hours  every  day,  is  to  use  one  to- 
day and  the  other  to-morrow;  for  instance,  if  a  nervine  and  a 
tonic  are  prescribed  separately,  let  them  take  full  doses  of  the 
nervine  on  Monday  and  full  doses  of  the  tonic  on  Tuesday, 
nervine  on  Wednesday,  tonic  on  Thursday,  etc.  Almost  any 
patient  can  and  will  alternate  thus  without  tiring. 

The  smaller,  the  more  striking  the  means  that  seem  to  pro- 
duce the  desired  result,  the  more  surprising  does  it  a])pear  to  a 
patient.  It  does  not  seem  wonderful  to  him  that  he  should  get 
better  after  taking  on  ounce  or  a  pint  of  anything,  but  for  relief 
and  improvement  to  follow  a  tiny  powder,  or  a  pellet,  or  a  taste- 
less solution,  or  a  morphia  granule  appears  marvelously  strange, 
and  commands  loud  praise. 

Instead  of  being  armed  with  paper  and  pencil  only,  carry 
with  you  a  few  well-chosen  remedies  to  be  used  at  night,  and 
on  occasions  of  great  or  sudden  emergency.  Above  all 
others,  carry  a  supply  of  morphia  granules  or  tablets  with 
you  constantly,  and  give  a  proper  number  of  them  in  an 
ounce  or  two  of  liot  water  as  soon  as  you  reach  one  of  the 
thousand  cases  in  which  great  pain  is  a  symptom.  By  so 
doing  you  can  often  adroitly  meet  the  emergency,  relieve  the 
suffering,  and  show  your  power  over  pain  before  the  messenger 
could  get  back  from  the  pharmacy  with  the  remedy  you  would 


242  THE   PHYSICIAN    HIMSELF: 

otherwise  order.  It  also  often  prevents  the  necessity  of  writing 
more  than  one  prescription  at  a  visit. 

Rest  for  the  patient  is  rest  for  the  nurse,  and,  when  all 
around  are  broken  down  and  worn  out,  this  is  an  important  con- 
sideration. The  value  of  a  night's  rest  to  a  very  ill  patient  is  often 
incalculable,  and  to  secure  this  morphia  granules  are  highly 
valuable,  even  when  -they  form  no  essential  part  of  the  treat- 
ment. You  can  also  use  them  to  give  any  jaded  sufferer  an 
occasional  night  of  delicious  visions,  or  of  placid  slumber,  that 
will  make  him  wonder  what  has  become  of  the  night. 

Morphia  granules  given  thus  make  a  vivid  impression  in 
the  physician's  favor,  and  do  great  good,  becoming,  in  fact, 
almost  a  perfect  substitute  for  morphia  hypodermatically. 

Endeavor  to  please  every  one's  taste  and  ideas  of  medicine 
as  far  as  is  compatible  with  safety,  and  bear  ever  in  mind  that  a 
patient  is  something  more  than  a  mere  stomach  and  body  ;  also, 
study  the  various  psychological  aids,  and  try  to  compel  the  pa- 
tient to  assist  mentally  in  curing  his  own  case.  Carefully  avoid 
overdosing,  and  remember  that  persons  who  have  been  most 
fond  of  taking  medicine  often  become  surfeited  and  undergo  a 
complete  revulsion  against  both  medicine  and  physicians.  How 
can  we  wonder  at  this,  when  even  too  long  a  continuation  of 
beefsteak,  partridge,  or  other  savory  food  causes  disgust,  even 
in  well  people ! 

This  tendency  in  the  human  mind  has  just  now  received 
a  wholesale  illustration  at  our  expense,  and  in  this  way: 
Satiated  and  disgusted  with  crude  and  overactive  measures,  a 
great  many  misdrugged  and  overdosed  people  were  wishing 
for  a  change,  when  lo!  Samuel  Christian  Friedrich  Hahne- 
mann, of  Meissen,  Germany,  accommodated  them  with  a  pseudo- 
scientific,  do-nothing  system,  resting  on  a  creed  composed  of  one 
logical  and  two  illogical  tenets,  which  nevertheless,  by  its  ap- 
parent simplicity,  serves  specially  to  advertise  both  system  and 
disciple,  and  to  fascinate  those  who  trust  to  it,  without  offending 
either  eye,  palate,  or  stomach ;  depending  on  nature  to  do  what 


HIS    REPUTATION    AND    SUCCESS.  240 

she  can  do,  while  itself  supinely  allowing  cases  that  she  cannot 
restore  to  become  complicated  or  chronic,  or  maybe  die  prevent- 
able deaths. 

"  Diseases  desperate  grown, 
By  desperate  appliances  are  relieved, 
Or  not  at  all." 

You  are,  of  course,  bound  by  the  most  sacred  obligation? 
to  use  your  best  judgment  and  endeavors  for  the  good  of  every 
one  who  comes  under  your  professional  care,  but  neither  the 
Code  of  Ethics  nor  the  Code  of  Honor  forbids  your  sailing  be 
fore  any  and  every  popular  breeze,  provided  you  violate  no 
principle  of  truth  or  justice.  No  honest  man  could  compromise 
a  matter  of  principle,  i.e.,  knowingly  quit  the  right  for  tlic 
wrong,  or  sell  the  truth  to  serve  the  hour,  or  for  one  moment 
permit  policy  to  sit  above  honesty ;  yet  it  is  sometimes  ver) 
foolish  not  to  compromise  a  matter  of  mere  policy.  In  medicine 
the  second-best  course  sometimes  becomes  the  best  because  the 
patient  likes  it  best ;  and,  although  you  can  neither  believe  no7 
follow  Hahnemann's  nonsense  and  follies, — 

"Your  key  fits  not  that  lock," — 

you  can  follow  the  fashion  of  the  day^  and  give  to  every  fastidi- 
ous or  squeamish  patient  the  smallest  and  most  pleasant  dose 
that  his  safety  will  permit,  and  can  avoid  giving  any  one  crude 
remedies  to  a  disgusting  degree. 

So  strong  has  been  the  reaction  against  old-timed  medica- 
tion, that  Hahnemann's  silly  system  has  secured  a  large  and 
earnest  following,  and  enjoys  the  sunshine  of  popular  favor 
among  the  susceptible  to  such  an  astonishing  degree  that  it  ma) 
be  regarded  as  the  grand  delusion  of  the  nineteenth  century, — 

"  How  long,  O  Lord,  how  long  !  " — 

and  there  is  to-day  no  (lawful)  human  occupation  that  yields  so 
large  a  return  for  the  amount  of  capital  and  brains  required  as 
the  practice  of  homoeopathy,  and  that  so  few  have  deserted  the 
crowded  paths  of  rational  medicine  to  seek  its  shekels  is  a  monu- 


244  THE    PHYSICIAN    HIMSELF: 

ment  to  man's  preference  of  the  true  and  noble  patli.  There 
can  be  no  doubt  that  its  prosperity  would  have  already  termi- 
nated had  the  profession  not  been  so  slow  to  accommodate  itself 
to  the  demands  of  fashion,  particularly  with  reference  to  medi- 
cation in  slight  and  imaginary  cases.  But  rational  physicians 
are  arousing  to  the  importance  of  this  feature,  and  are  rapidly 
conforming  to  it.  They  are  also  administering  more  concen- 
trated and  palatable  forms  of  medicines  in  serious  cases,  and, 
thanks  to  the  labors  of  many  devoted  workers  in  the  field  of 
medical  science,  and  to  the  light  they  have  shed  upon  the  sub- 
ject, are  now  enabled  to  effect  cures  with  greater  certainty, 
promptness,  and  safety  than  ever  before.  The  result  is  that 
many  of  the  erring,  who  had  gone  over  to  "isms"  and  "pathies," 
are  being  brought  back  from  delusions  to  renewed  faith  in  legiti- 
mate and  rational  methods  of  practice.  Determine  that  you  will 
bear  your  share  in  the  good  work  by  devoting  time  and  study  to 
rendering  therapeutics  useful  and  at  the  same  time  cheap, 
pleasant,  and  acceptable  to  patients.  If  you  will  carry  a  small 
pocket  vial-case  of  your  favorite  pills,  tablets,  granules,  etc.,  both 
strong  and  weak,  for  use  on  suitable  occasions,  you  can  meet 
homoeopaths  in  the  matter  of  free-dispensing,  and  also  have  as 
much  benefit  as  they  of  the  mystery  that  envelops  the  name  and 
nature  of  the  drugs  thus  employed.  Besides,  you  will  escape 
the  drug-store  "  repeats,"  and  if  there  be  any  repeating  you  will 
do  it  yourself. 

Now,  although  homoeopathy  is  somewhat  fashionable,  when 
a  disease  actually  requires  medication  you  can  make  little  if 
any  rational  use  of  its  so-called  principles,  which  rest  on  the 
following  foolish  postulates,  which  are  no  more  applicable  to 
the  treatment  of  disease  than  to  building  a  steam-boat :  Ist. 
Curative  remedies  for  the  side  can  he  selected  onhj  hij  a  study  of 
provings  on  jyersons  in  health.  2d.  Evert/  remedy  must  he  given 
by  itself  Sd.  The  similar  and  single  remedy  must  he  given  in 
its  ininimum  dose.,  i.e.,  the  smallest  dose  sufficient  to  effect  a  cure 
in  the  case.   These  constitute  Samuel  Christian  Friedrich  Hahne- 


HIS   REPUTATION    AND    SUCCESS.  245 

mann's  substitute  for  rational  tlierapeutics, — his  entire  stock  in 
trade ;  an  essential  triune,  an  inseparable  unit, — violation  of 
any  one  of  which  is  a  confessed  rejection  of  this  German 
dreamer's  whole  system,  and  you  will  observe  at  a  glance  that 
it  is  actually  two-thirds  nonsense ;  that  the  first  and  second 
postulates  of  his  creed  are  sophistical  and  untrue,  and  hence 
should  be  rejected;  and  that  the  last,  ?'.e.,  to  give  the  smallest 
dose  that  will  answer  the  purpose,  nobody  denies, — 

"It  is  as  old  as  the  itch," — 

since  it  is  useless  to  pour  two  buckets  of  water  on  a  fire  when 
sure  that  one  will  put  it  out. 

Contrary,  however,  to  what  many  unthinking  people  believe, 
this  creed  gives  its  disciples  perfect  liberty  to  give  either  an  atom 
or  an  ounce  of  mercury,  sugar,  opium,  or  anything  else,  at  a 
dose,  provided  they  proceed  on  the  so-called  principle  of  simi- 
lars; and  the  question  whether  any  one  does  or  does  not  prac- 
tice homcEopathically  does  not  at  all  depend  upon  the  size  of  the 
doses.  They  might  give  an  ounce  of  a  medicine  where  you 
would  give  but  a  grain.  Their  ounce  would  not  make  them 
regular  physicians,  nor  your  grain  make  you  a  homceopathist, 
for  you  in  selecting  your  remedies  would  not  think  of  pathies 
at  all,  while  they  would  think  of  nothing  else. 

Bear  in  mind  that  the  practice  of  rational  medicine  is  also  as 
distinct  and  free  from  allopathy  and  all  other  pathies  as  America 
is  from  Asia.  Here  is  the  true  and  only  test  as  to  whether  you 
are  practicing  rationally,  homoeopathically,  or  allopathically : 
Were  you  to  examine  a  patient  and  ask  yourself,  without  regard 
to  nonsensical  pathies,  or  to  any  other  creed  or  boundary.  What 
is  the  best  treatmeyit  known  to  the  world  for  a  case  like  the  one 
before  we  ?  and  use  that,  you  would  be  practicing  rational^  unre- 
stricted, regular  medicine.  If,  on  the  contrary,  you  were  to 
examine  a  patient  (with  the  Will-o'-the-wisp  idea  of  liomoeopa- 
thy  in  your  mind),  and  ask  yourself,  What  article  icould  pro- 
duce a  totality  of  symptoms  similar  to  his  in  a  well  j^^J'son  ? 
and  give  him  the  one  which  you  thought  would  come  nearest  to 


246  THE    PHYSICIAN    HIMSELF: 

doing  this,  you  would  be  practicing  homceopathically ;  or  were 
you  to  sit  down  (with  the  chimera  of  allopatliy  in  your  mind), 
and  ask  yourself  what  article  would  jingle  with  another  sympa- 
thy or  totality  of  symptoms  dissimilar  to  these,  and  irrationally 
base  your  treatment  on  that  ground,  you  would  be  practicing 
*allopathically.  Now,  it  is  safe  to  conclude  that  if  you  practice 
medicine  forty  years  you  will  never  sit  down  by  a  patient's  bed- 
side (conjure  the  pathies)  and  ask  yourself  either  "  What 
agent  would  produce  a  disease  similar  to  this,  or  symptoms 
similar  to  these  in  a  well  person  ■?"  or  "  What  would  cure  by 
agreeing  with  dissimilar  sympathies  1  "  and  attempt  to  simulate 
this  in  your  treatment.  Therefore,  remember  that,  no  matter 
liow  small  your  dose,  or  what  the  article,  or  by  whom  first  used 
as  a  medicine,  it  would  not  be  given  by  the  square  and  compass 
of  the  so-called  pathies  at  all,  and  you  would  be  proceeding 
neither  liomoeopatliicaHy  nor  allopathically,  but  rationally. 

It  is  also  safe  to  predict  that  while  reason  remains  your 
mistress  you  can  never  agree  that  twelve  twelves  make  a  hun- 
dred and  fort)'-five,  or  follow  a  system  of  symptom-worship  that, 
in  dogmatically  seeking  to  follow  the  (so-called)  law  oi'  similars, 
arrives  at  poison  oak-globules  as  a  remedy  for  erysipelas,  croton- 
oil  globules  as  a  remedy  for  cholera  infantum,  mercury  globules 
for  mumps,  tartar-emetic  globules  for  typhoid  pneumonia,  opium 
globules  for  apoplexy,  strychnia  globules  for  convulsions,  can- 
tharides  globules  for  burns,  and  an  immense  farrago  of  other 
nonsense  as  true  as,  but  no  truer  than — 

"There  was  a  man  in  our  town,  and  he  was  wondrous  wise. 
He  jumped  into  a  bramble-bush  and  scratclied  out  both  his  eyes. 
And  when  he  saw  his  eyes  were  out,  with  all  his  might  and  main, 
He  jumped  into  another  bush  and  scratched  them  in  again." 

Study  the  "  Organon  of  Medicine,"  by  Samuel  Hahnemann  ; 
"  Homoeopathy  Fairly  Represented,"  by  Henderson ;  Hull's 
"Jahr";  Hughes's  "  Pharmaco-Dynamics  " ;  Johnson's  "  Thera- 
peutic Key  " ;  the  works  of  Hering,  Lippe,  and  Guernsey,  and 
you  will  read  that  a  homoeopath  must  prescribe  according  to 
what  he  claims  to  be  the  homoeopathic,  the  SOLE,  law  of  nature 


HIS    REPUTATION    AND    SUCCESS.  247 

in  therapeutics,  comprehended  in  the  phrase  "  similia  similihas 
curantiu^''  or  like  cures  Hke.  It  is  this  SOLE-LAW  pretension 
and  false  claim  to  an  exclusive  possession  of  therapeutical  truth 
that  stamp  homoeopathy  a  variety  of  quackery. 

"Vaulting  ambition,  that  o'erleaps  itself, 
And  falls  on  the  other  side." 

It  is  universally  admitted  that  quinia  cures  intermittent 
fever,  but  who  ever  heard  of  its  being  homoeopathic  to  the 
periodic  feature  of  that  disease "?  And  yet  where  is  the  homoeo- 
path who  does  not,  in  periodic  fevers,  administer  sugar-coated 
quinine  granules  in  full  doses'?  Podophyllin  is  the  favorite 
cathartic  of  the  homoeopath.  Does  it  ever  cause  constipation 
except  by  the  secondary  exhaustion  and  impairment  of  sensi- 
bility common  to  all  cathartics?  No  intelligent  physician  would 
contend  that  it  did.  That  morphia  relieves  pain  is  one  of  the 
best-attested  facts  of  medical  observation ;  will  any  homoeopath 
dare  say  that  it  causes  pain  1  These  are  not  stray  assertions  ; 
they  are  monumental  facts,  destined  to  overturn  homoeopathy 
and  its  silly  law  of  similars ;  for  neither  S.  C.  F.  H.'s  nor  any 
one  else's  pseudology  can  maintain  itself  permanently  before  the 
light  of  truth  and  science. 

Truth  is  a  unit ;  there  can  be  but  one  science  of  one  sub- 
ject, and  there  is  but  one  science  of  medicine,  and  to  talk  of 
rival  systems  of  medicine  is  as  absurd  as  to  talk  of  rival  systems 
of  mathematics  or  rival  laws  of  gravity.  Compare  S.  C.  F.  H. 
(whose  whole  life  was  full  of  unnatural  thoughts,  foolish  ideas, 
and  peevish  fancies)  and  the  shallow  and  delusive  so-called  sole 
law  of  cure,  published  in  his  "  Organon,"  in  1810,  in  which  he 
rails  at  the  profession  and  talks  as  if  he  alone  had  charge  of  the 
key  of  knowledge  and  the  casket  of  truth,  all  the  way  through, 
with  Copernicus,  Newton,  Harvey,  Davy,  Galileo,  Franklin,  and 
other  real  discoverers  of  nature's  laws,  who  are  an  honor  to  the 
human  race,  and  you  will  find  his  baseless  and  unscientific  chain 
of  assertions  so  weak  that 

"Whatever link  we  strike, 
Tenth  or  ten  thousandth,  breaks  the  chain  alike." 


248  THE   PHYSICIAN    HIMSELF: 

Those  illustrious  men  did  discover  the  natural  laws  of 
astronomy,  gravitation,  electricity,  etc. ;  consequently,  their  sys- 
tems have  extended  or  have  been  but  slightly  changed. 

"Truth  is  God's  own  daughter." 

Hahnemann  did  not  discover  the  natural,  the  sole,  the  universal 
law  of  medicine ;  therefore  his  frail,  temporary  system  has  beaten 
about  from  psora  and  dynamization  to  the  tasteless,  the  infini- 
tesimal, etc.,  until  to-day  it  scarcely  exists  except  in  name. 

Among  S.  C.  F.  H.'s  chief  doctrines  was  the  dynamization 
(spiritualization)  of  medicines,  and  his  angry  assertion  that  a 
millionth  of  a  grain  of  medicine  had  more  power  than  a  grain, 
or  that  a  drop  of  alcohol  well  shaken  had  more  power  than  an 
unshaken  pint,  goes  far  to  illustrate  his  unparalleled  assurance 
and  egotism. 

"Yet  still  some  wondered — and  the  wonder  grew — how  one 
small  head  could  carry  all  he  knew." 

These  notions  of  his  not  only  contradict  reason  and  violate 
common  sense,  but  conflict  with  fixed  mathematical  laws,  since 
a  part  cannot  be  greater  than  the  whole.  The  truth  is,  the 
so-called  dynamization,  or  attenuation,  or  spiritualization  of 
medicines  is  bosh,  and  bears  about  as  much  relation  to  the 
science  of  medicine  as  the  kaleidoscope  does  to  the  science  of 
astronomy.  Indeed,  were  some  graceless  wag  to  exchange  or 
mix  up  the  contents  of  a  disciple's  satchel  so  that  each  vial 
would  contain  attenuations  the  very  opposite  of  its  label,  its 
owner,  in  blissful  ignorance  of  the  fact,  would  doubtless  con- 
tinue to  hear  of  their  great  usefulness  all  the  same. 

To  test  the  value  of  dynamization  the  Milwaukee  Academy 
of  Medicine,  in  1878,  made  the  following  offer :  a  vial  of  sugar 
pellets,  moistened  with  the  30th  attenuation  of  a  drug  and 
placed  among  a  number  of  vials  of  sugar  pellets  moistened  with 
alcohol  only,  to  be  given  to  each  believer  in  dynamization  found 
willing  to  use  them,  he,  at  the  end  of  one  year,  to  designate  by 
their  effects  on  his  patients  which  of  the  vials  contained  the 
medicated  pellets. 


HIS    REPUTATION    AND    SUCCESS.  219 

The  project  was  indorsed  by  the  leading  journals  and  by 
The  New  York  Homoeopathic  Medical  Society.  A  mixed  com- 
mittee of  believers  and  unbelievers,  of  which  E-ev.  Geo.  T. 
Ladd,  Professor  in  Bowdoin  College,  Maine,  was  the  Chairman, 
dispensed  the  sets  of  pellets,  giving  them  to  none  but  avowed 
believers  in  the  efficacy  of  attenuations,  each  applicant  being- 
allowed  to  name  the  drug  he  would  use  in  the  trial. 

The  result  was  as  follows :  Number  of  trial  sets  applied 
for,  seventy-two ;  number  who  ventured  to  report  at  the  end  of 
the  year,  ten ;  number  who  found  the  medicated  vial,  one. 

Since  this  we  have  heard  less  and  less  of  dynamization. 
Hear  Hahnemann  himself  on  the  subject : — 

"  It  holds  good,  and  will  continue  to  hold  good,  as  a 
homoeopathic  therapeutic  maxim,  not  to  be  refuted  by  any 
experience  in  the  world,  that  the  best  dose  of  the  properly- 
selected  remedy  is  always  the  very  smallest  one  in  one  of  the 
high  dynamizations,  as  well  for  chronic  as  for  acute  diseases." 

Remember  that  the  epithet  or  by-word  "Allopath  "  is  a 
false  nick-name — 

"A  thing  devised  by  the  enemy" — 

not  chosen  by  regular  physicians  at  all,  but  coined  for  us, 
and  put  in  use  against  us,  by  our  enemy,  S.  C.  F.  Hahnemann, 
in  contradistinction  to  his  own  dreamy  system,  to  prove  that 
the  theory  and  therapeutics  he  proposed  in  his  absurd  "'  allo- 
pathy's "  place  was  of  a  totally  different  or  opposite  character 
from  it ;  and  cunningly  used  as  part  of  his  ridiculous  attempt 
to  blot  out  all  the  existing  facts  of  free  therapeutic  science,  and 
to  substitute  his  own  silly  system,  and  now  applied  to  us 
opprobriously,  with  all  the  collateral  insinuations  and  derisive 
use  the  term  affords,  by  all  our  rivals  and  enemies,  with  intent 
to  injure. 

"As  the  old  bird  sings,  the  young  ones  twitter." 

It  is  both  untrue  and  offensive,  and  is  no  more  accepted  by 
us  than  the  term  "Heretic"  is  accepted  by  Protestants,  "Ch — t- 
killers  "  by  the  Jews,  or  "  Locofoca  "  by  the  Democrats. 


250  THE    PHYSICIAN    HIMSELF: 

Bear  in  mind  that  we  do  not  study  the  so-called  pathies  at 
all ;  therefore,  are  not  "  paths  "  of  any  kind,  but  are  Rational, 
Unrestricted  Physicians,  and  take  care  resolutely  and  promptly 
to  resent  the  term  "Allopath "  when  any  one  applies  it  to 
you  through  enmity,  and  courteously  to  disown  it,  and  tell 
of  its  falsity,  hostile  origin,  and  sinister  intent,  when  applied  by 
those  who  do  not  know  what  malice  the  term  implies. 

S.  C.  F.  H.'s  so-called  allopathic  physician  would  be  one 
whose  silly  creed  tied  him  to  a  jargon  of  pathies  and  confined 
him  to  fiddling  on  what  dreamers  call  "  opposite  sympathies," 
even  trying  in  practice  to  create  some  dissimilar,  perhaps  worse, 
disease,  as  a  substitute  for  the  one  he  was  called  upon  to  treat. 
Now,  there  are  fully  a  hundred  times  as  many  squinting-brained 
people  in  every  community  as  there  are  squint-eyed  persons, 
and  any  man,  with  but  one  eye  even,  can  see  why  policy  and  self- 
interest  bring  forth  Protestant  bakers  and  Catholic  gardeners. 
Baptist  washerwomen  and  Quaker  boot-blacks.  Mormon  black- 
smiths and  Presbyterian  shoe-makers,  Masonic  carpenters  and 
Odd  Fellow  bricklayers,  Bepublican  barbers  and  Democratic 
tailors,  Methodist-Episcopal  astronomers,  Homoeopathic  doctors, 
French  mathematicians,  and  Botanical  druggists,  whenever 
and  wherever  there  are  squinting-brained  people  who  prefer  to 
employ  dogmatists  in  these  things.     Verily  it  seems  as  if 

"  All  the  world's  a  stage, 
And  men  and  women  merely  players  ;" 

but  everybody  knows  that  no  sensible  person  wants  a  (Hetero- 
pathic)  physician  who  will  cure  one  disease  or  symptom  by^ 
creating  some  contrary,  perhaps  worse,  one ;  consequently,  no 
thinking  person  professes  to  be  an  Allopath,  and  no  unrestricted 
physician  should  allow  himself,  or  the  regular  profession  which 
he  represents,  to  be  thus  belied  and  belittled ;  but  there  is,  and 
ever  will  be,  everywhere,  a  dozen  times  greater  demand  for 
unrestricted,  rational  practitioners  of  medicine,  who  will  do 
whatever  under  heaven  seems  best  for  their  patients,  without 
regard  to  likes  or  contraries,  creeds  or  pathies,  than  for  one  of 


HIS    REPUTATION    AND    SUCCESS.  251 

any  other  kind.  Away,  then,  at  once  and  forever,  with  the 
absurd  and  false  title  "  Allopath !"  and,  if  a  designating  title 
becomes  necessary,  let  it  be  Regular  or  Unrestricted  Physician. 

Also,  in  signing  certificates  for  life-insurance  or  beneficial 
societies,  or  in  giving  your  name  for  directories,  State  or  city 
registers  of  physicians,  or  in  other  cases  in  which  the  form 
requires  you  to  state  what  school  of  medicine  you  practice,  be 
careful  to  have  your  name  mentioned  as  a  regular  or  rational 
physician,  or  simply  "  physician,"  and  not  as  an  allopathist. 

Folly-engendering  homoeopathy  not  only  panders  to  the 
whims  of  the  whimsical,  but  also  makes  a  specialty  of  poison- 
ing their  minds,  as  well  agahist  clearly  rational  remedies  as 
against  the  lancet,  polypharmacy,  and  other  debatable  or 
spoliative  measures,  and  inclines  them  to  attach  undue  impor- 
tance to  every  trivial  afiection,  and  to  overestimate  the  value 
of  placebo  treatment,  and  thus  not  only  tends  to  produce  an 
effeminate  type  of  patients,  who  cowardly  shrink  from  every 
ailment,  but  also  creates  a  pathophobic  overattention  to  the 
minutiae  of  health,  and  eventually  makes  them  morbidly  anxious 
about  every  function,  and  fills  their  mind  with  a  medley  of 
imaginary  and  exaggerated  afiflictions,  which  haunt  them,  like 
Banquo's  ghost,  wherever  they  go. 

"  In  form  a  man, 
With  spirit  less  than  infancy, 
And  nerveless  as  the  weakest  woman." 

You  will  often  see  persons  who  might  have  passed  through 
life  well  and  strong,  with  scarcely  a  thought  of  sickness,  who, 
from  being  indoctrinated  in  it,  softened  by  its  follies,  and 
habituated  to  its  self-surveillance  and  constant  contemplation 
of  their  symptoms,  become  borne  down  into  valetudinarianism 
or  hypochondriasis  by  a  net-work  of  magnified  trifles,  and  con- 
stant indications  for  pellets  and  attenuations. 

"I'm  doing  this  for  my  health, 
I'm  doing  this  for  my  health, 
For  my  health,  for  my  health, 
I'm  doing  this  for  my  health." 


252  THE    PHYSICIAN    HLMSELF  I 

We  have  a  wealthy  but  very  fanciful  lady  living  in  our 
section  who  has  become  so  enamored  ol'  similia,  etc.,  that, 
besides  incessantly  hunting  up  indications  and  symptoms  in 
herself,  and  dosing  herself  with  globules  of  table-salt  when  she 
dreams  there  are  robbers  in  the  house,  of  veratrum  when  she 
dreams  she  eats  her  shoes,  and  of  hyoscyamus  when  she  dreams 
she  climbs  the  stove-pipe,  she  also  banquets  her  birds  on  globules 
of  sun-dew%  etc.,  whenever  they  fail  to  sing,  and  Tabby  and 
Tommy  w^hen  they  fail  to  mew.  Other  silly  but  zealous  Hahne- 
maniacs,  as  if  to  complete  the  absurdity  and  show  their  zeal 
and  childlike  fascination,  have  given  its  similars  to  turkeys, 
dogs,  chickens,  horses,  geese,  etc.,  and  would  almost  ask  you 
to  believe  that  they  had  seen  it  change  a  red  calf  with  blue 
eyes  into  a  blue  calf  with  red  eyes. 

"O  dark,  dark,  dark;  total  eclipse. 
Amid  the  blaze  of  noon." 

Not  only  this,  but  read  the  provings  in  any  standard 
homoeopathic  work, — Hughes's  "  Pharmaco-Dynamics,"  for  in- 
stance,— and  you  will  find  that  many  of  their  remedies  and 
many  of  the  symptoms  said  to  follow  homoeopathic  provings 
are  too  nasty  to  be  repeated,  and  that  the  majority  of  the  others 
are  more  like  the  idle  fancies  of  SpirituaUsts  or  day-dreamers 
than  the  work  of  rational  persons. 

You  will  discover  that  nine  out  of  ten  of  those  who  to-day 
long  for  its  sweet  nothings  know  absolutely  naught  about  the 
so-called  principles  and  sophistical  calculations  of  homoeop- 
athy, BUT  (and  this  is  a  big  but)  take  themselves  and  give 
their  sugar-plum  Materia  Medica  to  their  families  solely  because 
their  remedies  are  fashionable,  novel,  easy  to  take,  and  prevent 
the  trouble  and  expense  of  running  to  the  druggist  with 
prescriptions. 

Homoeopathy  has  also  profited,  and  is  still  profiting,  wher- 
ever the  English  language  is  spoken,  by  the  accidental  mis- 
leading resemblance  of  the  term  homoe  to  the  precious  word 
home, — "  Home,  sweet  home." 


HIS    REPUTATION    AND    SUCCESS.  253 

To  you,  as  a  physician,  the  term  homoeopath  naturally 
signifies  a  person  who  practices  a  certain  silly,  dogmatic,  and 
visionary  system.  But  to  many  of  the  laity,  on  the  contrary,  the 
first  two  syllables  of  the  word  suggest  that  he  practices  a  simple 
liome  or  domestic  system  of  medicine,  and  the  fact  that  he  ordi- 
narily prepares  his  own  globules,  solutions,  etc.,  either  at  his 
own  home  or  at  the  homes  of  those  who  employ  him,  instead  of 
sending  prescriptions  to  drug-stores  as  we  do,  adds  strength  to 
this  popular  error,  which  is  so  natural  that  many  people  often 
actually  call  regular  physicians  who  happen  to  supply  their  own 
medicines  "  Home-o-paths." 

It  is  your  duty,  in  the  interest  of  truth  and  for  the  benefit 
of  humanity,  to  make  it  known  that  the  word  "  home  "  is  of 
Saxon  derivation,  whereas  the  prefix  homoeo  is  derived  from  the 
Greek  homoios  (similar),  and  has  no  possible  relation  to  hearth 
and  home.  S.  C.  F.  H.  seems  to  have  built  better  than  he 
knew,  as  far  as  the  home-loving,  English-speaking  Americans 
are  concerned,  when  he  styled  himself  a  homoeopathist,  and  not 
a  pathomoeist,  which  has  the  same  meaning. 

Do  not  infer  that  no  homoeopath. (or  omnipath,  or  hydro- 
path,  or  vitopath,  or  any  other  path  or  ist)  can  be  influenced 
by  the  very  quintescence  of  high  motives,  or  be  following  his 
2:)atliy  with  the  full  purity  of  truth  and  the  perfect  honorable- 
ness  of  honesty,  and  with  the  sincerest  intention  of  giving  the 
utmost  assistance  and  relief  that  the  art  of  medicine  enables 
one  to  give ;  for  there  never  has  been  an  absurdity  in  regard  to 
religious,  political,  or  medical  questions  that  has  not  found  very 
sincere,  well-meaning  supporters,  educated,  refined,  and  zeal- 
ously in  earnest,  who  have  somehow  or  other  been  led  into 
those  paths  ;  nor  that  a  homoeopath  does  no  good,  for  he  may  do 
a  great  deal  of  good,  and  even  get  patients  well,  but  the  good  he 
does  is  not  by  his  silly  pathies,  as  has  been  proven  by  innumer- 
able observers,  but  by  the  accompanying  tact  of  tongue,  hygien- 
ics, dietetics,  faith,  expectation,  good  nursing,  time,  etc.,  which 
would  do  equally  much  were  the  patliy  portion  left  out,  and 


254  THE   PHYSICIAN    HIMSELF  I 

globules  of  sugar,  saw-dust  pills,  colored  water,  or  any  other 
make-believe  remedy  substituted,  to  give  the  confiding  room  to 
exercise  their  faith,  and  rest,  regimen,  the  vital  force,  time,  etc., 
an  opportunity  to  make  the  cure. 

A  preacher,  a  lawyer,  or  an  agriculturalist  may  be  a  fraud ; 
or  a  navigator,  an  astronomer,  or  a  mathematician  may  be  a 
swindler,  while  the  system  by  which  they  pretend  to  be  guided 
is  perfectly  true.  But  homoeopathy  is  the  reverse  of  all  these ;  it 
itself  is  nothing  but  a  fanciful  pseudo-science ;  hence,  not  solely 
the  disciple,  but  the  system  itself  sins  against  truth. 

If  ever  chance,  or  a  crossing  of  paths,  bring  you  in  contact 
with  a  real  homoeopathist,  if  you  believe  him  to  be  a  gentleman, 
harbor  no  ungenerous  feelings  or  personal  animosity,  and 
observe  all  the  forms  of  politeness  toward  him,  and  treat  him 
exactly  as  you  would  any  other  gentleman, — 

His  faith  may  be  as  sincere  as  yours, — 

but  ignore  him  (as  he  probably  will  you)  pr-ofessionalli/,  and 
make  no  attempt  to  fraternize  with  him  in  the  management  of 
a  case,  it  being  far  better  for  each  kind  to  consult  with  its  own. 

Suppose  you  were  to  attempt  to  consult:  patient  has — 
well,  say,  convulsions,  the  result  of  teething.  You  examine 
the  case  together — retire  for  consultation — the  subject  of  treat- 
ment is  finally  reached.  You  (true  to  humanity)  survey  the 
whole  field  of  rational  therapeutics  and  conclude :  first,  that 
the  cause  should  be  removed  a^  far  as  possible  by  incising  the 
gums  for  the  purpose  of  severing  their  irritated  nerves ;  second^ 
that  sedatives  and  antispasmodics  are  indicated.  He  (true  to 
his  creed)  puts  on  his  homoeopathic  spectacles,  surveys  the 
totality  of  symptoms  by  the  square  and  compass  of  Similia 
Similibus  Curantur,  and  arrives  at  strychnia,  in  the  tenth  dilu- 
tion !  Result :  emphatically  a  therapeutic  dead-lock,  unless, 
false  to  your  convictions,  false  to  your  profession,  and  false  to 
the  interests  of  humanity,  You  agree  to  give  up  common  sense 
for  his  nonsense. 

But  how,  oil,  liow  !   can  anv  true  man  have  much  to  da 


HIS   REPUTATION    AND    SUCCESS.  255 

with  any  of  the  other  flock, — the  degenerate  knaves  who  are 
not  homoeopaths  at  all,  but  solely  for  business  reasons  burlesque 
as  homoeopaths  and  carry  awe-inspiring  satchels  of  Hahneman- 
nic  nonsense  which  they  handle  as  carefully,  in  walking  the 
streets,  in  getting  in  and  out  of  their  buggies,  in  going  up  stairs, 
and  in  opening  and  closing  them  in  the  sick-room,  as  if  an 
additional  (here  is  where  the  biggest  laugh  comes  in)  shake  of 
the  powerful  dynamizations  within  might  still  further  increase 
their  terrific  potency  and  cause  an  explosion. 

He  seems  as  far  from  fraud  as  heaven  from  earth. 

The  whole  life  of  such  a  fellow,  though  he  lives  in  luxury  and 
rolls  in  a  gilded  chariot,  is  a  living  lie, — a  sad  burlesque  on 
physic,  a  long-drawn  ode  to  finesse. 

Respect  every  believer  in  anything,  no  matter  how  great 
his  error,  if  his  views  be  honestly  held,  provided  he  show  his 
true  colors  and  fight  a  fair  battle  for  it ;  but  let  the  finger  of 
scorn  point  at  every  so-called  son  of  Hahnemann  who,  as  an 
advertisement  of  himself  and  to  catch  patients,  denounces  and 
sneers  at  "Allopaths"  and  '-^  old-scIiooV^  remedies,  meanwhile 
giving  pellets  and  attenuations  in  placebo  cases  only^  and  in  all 
others  slyly  using  our  opium  to  relieve  pain,  our  chloral  to 
induce  sleep,  our  quinia  and  antipyrin  to  arrest  fever,  and  all 
our  other  prominent  agents,  just  as  we  do,  in  full  doses,  yet 
crediting  the  good  they  do  to  similia  simiUbus  curantur,  be- 
cause just  now  to  call  one's  self  a  homoeopathist  and  dispense 
pellets  free  to  all  who  will  pay  for  advice,  and  to  surround 
the  name  and  nature  of  the  remedies  with  mystery,  brings  grist 
to  one's  mill  and  shekels  to  his  coffers;  but, 

"What  soul  would  in  such  a  carcass  dwell?" 

There  is  also  another  variety  of  fellows,  who  talk  homoe- 
opathy to  one  person  and  anything-you-wish  to  the  next. 
These,  although  inconsistent  with  themselves,  are  not  so  pos- 
itively dishonorable,  for  they  are  at  least  outspoken  in  their 
doubleness ;  but  what  words  would  exaggerate  the  meanness  of 
a  clergyman  whose  love  of  gold  and  lack  of  scruple  would  allow 


256  THE   PHYSICIAN    HIMSELF  I 

him  to  vary  his  principles  at  v:iU  and  preach  anything  one 
wished,  whether  a  strictly  Catholic  lecture,  or  an  ultra-Protes- 
tant discourse,  an  orthodox  Hebrew  sermon,  a  fiery  Mohamme- 
dan philippic,  or  an  out-and-out  infidel  harangue'?  He  might 
believe  in  one  or  none,  but  he  could  not  believe  in  all,  and,  if 
he  professed  to  do  so,  would  deserve  to  be  kicked  out  of  his 
own  door. 

"An  eagle's  life 
Is  worth  a  world  of  crows." 

Science  has  everywhere  convincingly  shown  that  Homoe- 
opathy contains  its  own  refutation,  and  is  a  fraud  on  science. 
Hahnemann  started  it  in  1790,  six  years  before  Jenner  vacci- 
nated James  Phipps,  and  his  "  Organon"  was  published  in  1810. 
Now,  in  this  long,  long  period,  had  it  deserved  scientific  recog- 
nition, or  had  there  been  anything  at  all  in  it  worthy  of  adop- 
tion by  the  profession,  it  would  surely,  like  vaccination,  elec- 
tricity, and  all  other  truths,  long  since  have  been  absorbed  by 
scientific  rational  medicine,  whereas  the  fact  is  that  its  silly 
creed  has  taken  no  root  at  all  in  the  regular  profession.  To-day 
pure  homoeopathy  is  withering  like  a  girdled  fig-tree  in  Europe j 
and  Hahnemann  is  no  longer  placed  on  a  lofty  pedestal — 

"  Take  him  for  all  in  all, 
"We  scarce  shall  look  upon  his  like  again" — 

or  worshiped  as  a  hero,  and  his  silly  system  has  almost  faded 
out  in  the  land  of  its  birth,  and  is  without  a  chair  in  any  uni- 
versity in  Europe,  and  is  rarely  mentioned  there  without  a  smile. 
The  Homoeopathic  Medical  Directory,  recently  published 
in  London,  shows  that  there  were  in  Great  Britain  and  Ireland, 
in  1875,  two  hundred  and  sixty-nine  homoeopaths,  and  in  1889 
but  two  hundred  and  fifty-six.  In  Austria  there  are  now  seven 
thousand  one  hundred  and  eighty-three  physicians,  of  whom  but 
one  hundred  and  eighteen  claim  any  connection  with  homoe- 
opathy, and  only  forty-four  of  these  profess  to  practice  it  exclu- 
sively ;  Germany  was  its  birtli-place,  yet  there  are  but  nineteen 
in  all  Vienna ;  and  in  all  Europe,  with  a  population  of  at  least 


HIS   REPUTATION    AND    SUCCESS.  257 

three  hundred  millions  of  souls,  there  are  now  but  one  thousand 
and  twenty-two  so-called  homoeopaths, — an  actual  decrease,  and 
that,  too,  in  the  face  of  an  enormous  increase  of  the  number 
of  regular  physicians. 

Even  here,  in  Free  America,  it  has  passed  its  zenith,  its 
feast  is  almost  over,  and  its  Mene,  Mene,  Tekel  is  already  on 
the  wall,  for  it  has  almost  ceased  to  be  the  topic  of  conversation 
in  fashionable  circles ;  the  homoeopathic  book  and  case  of  num- 
bered globules  are  also  fast  disappearing  from  the  hands  of  the 
laity ;  its  so-called  specifics  are  kept  among  the  patent  medicines 
in  every  drug-store;  the  system  is  no  longer  exciting  amateurs, 
and,  far  above  all,  its  wholesale  desertion  of  its  own  principles  is 
about  to  furnish  another  proof  that  no  religious  creed,  no  political 
doctrine,  no  medical  ism  or  pathy,  can  extend  beyond  a  limited 
sphere  or  period,  if  it  be  opposed  to  the  common  sense  of 
mankind. 

The  New  York  Homoeopathic  Medical  Society  and  other 
homoeopathic  bodies  now  merely  consider  Similia  Similibus 
Curantur  the  best  general  guide  in  selecting  remedies,  BUT  from 
which  any  may  depart,  if  experience  or  his  individual  judgment 
so  direct. 

Well  !  well  !  !  well  !  !  !     Shades  of  departing  greatness. 

Homoeopathy  has  temporarily  maintained  its  ground  here 
not  from  any  intrinsic  merit,  but  chiefly  because  its  pellets,  etc., 
are  easily  gotten  and  at  small  cost,  and  easily  applied  in  self- 
medication  at  the  home  or  from  the  pocket  of  its  votaries. 

In  considering  the  nothingness  of  homoeopathy,  think  what 
it  is  to-day, — that  its  disciples  no  longer  follow  their  master,  that 
every  change  they  make  is  toward  regular  practice,  and  that 
the  vast  majority  of  its  representatives  seem  to  be  on  their  way 
back  to  Regular  practice  in  everything  except  in  name  and 
affiliation. 

When  Hahnemann  started  homoeopathy,  the  sciences 
upon  which  modern  medicine  is  based — chemistry,  physiology, 
pathology,  etc. — had,  practically,  no  existence,  and  it  was  this 


258  THE    PHYSICIAN    HIMSELF: 

and  the  overmedication  of  former  days  that  gave  it  the  start. 
Were  any  one  to  originate  such  a  silly  system  to-day  there 
could  be  no  excuse  for  its  existence,  and  it  would  either  fall 
still-born  or  be  laughed  to  death. 

Study  the  homceopathic  creed  closely,  and  then  carefully 
watch  the  practice  of  all  those  who  to-day  claim  to  practice 
under  it,  of  whom  you  have  personal  knowledge,  and  you  will 
soon  discover  that  few  (if  any)  honestly  do  so ;  and  although 
the  number  of  those  who  pretend  to  practice  homoeopathy  may 
still  be  somewhat  on  the  increase  in  this  country,  and  enthusiasts 
here  and  there  are  still  donating  and  bequeathing  money  and 
holding  fairs  for  the  benefit  of  homceopathic  colleges,  hospitals, 
dispensaries,  and  societies,  and  its  disciples  are  boasting  over  their 
numerical  increase  and  exulting  over  this  political  favor  they 
have  secured,  and  over  that  iiifiiiential  patient  they  have  netted, 
and  over  the  other  fresh  partisan  who  is  praising  it,  just  as  they 
were  in  Europe  thirty  or  thirty-five  years  ago ;  yet,  pure  homoe- 
opathy itself — similia,  etc.,  based  on  provings — is  rapidly  dis- 
appearing, and  I  sincerely  doubt  whether  there  are  at  this  time 
half  a  dozen  omnibus-loads  of  true  Hahnemannic  homoeopaths 
in  our  land,  and  for  the  confirmation  of  this  assertion  I  refer  to 
any  qualified  pharmacist  or  manufacturer  of  granules,  tablets, 
and  pills  who  comes  in  contact  with  the  homoeopathic  thera- 
peutics of  to-day.  The  genuine  homoeopath  never  prescribes 
tonics,  never  orders  mineral  waters,  never  gives  emulsions,  never 
alternates  or  mixes  remedies,  and  never  uses  hypodermatic  in- 
jections, purgatives,  mustard  plasters,  ointments,  lotions,  washes, 
liniments,  medicated  injections,  cauterizations,  sprays,  or  gargles : 
and  whoever  does  so  is  under  the  bitter  anathemas  of  Hahne- 
mann, who  said :  "  He  who  does  not  walk  on  exactly  the  same 
line  with  me,  who  diverges  if  it  be  but  the  breadth  of  a  straw, 
to  the  right  or  to  the  left,  is  an  apostate  and  a  traitor,  and  with 
him  I  will  have  nothing  to  do." 

"  More  miglit  be  said  hereof  to  make  a  proof. 
Yet  more  to  say  were  more  than  is  enough." 


CHAPTER  X. 

"Behold,  how  good  and  how  pleasant  it  is  for  brethren  to  dwell 
together  in  unity  !  " 

Be  just  and  friendly  toward  every  worthy  pharmacist. 
Owing-  to  the  relationship  and  mutual  dependence  between 
pharmacy  and  medical  practice,  the  pharmacists  are  your  natural 
allies,  and  should  receive  your  respectful  regard.  Probably  all 
physicians  will  agree  that  in  the  ranks  of  no  occupation  can  a 
greater  proportion  of  gentlemen  and  manly  men  be  found  than 
in  the  pharmaceutical.  This,  and  your  joint  interests,  should 
make  you  brothers. 

It  will  be  found  an  excellent  rule  strictly  to  avoid  favor- 
itisms  and  antagonisms,  and  to  let  all  reliable  pharmacists  com- 
pete for  your  prescriptions  and  for  the  family  patronage  which 
they  influence.  You  will  make  a  serious  mistake,  and  engender 
active  enemies,  too,  if  you  go  out  of  your  way  and  without  just 
cause  instruct  patients  to  obtain  their  medicines  from  any  par- 
ticular pharmacy ;  if  a  prescription  be  properly  compounded  it 
makes  but  little  difference  by  whom,  so  the  compounder  i& 
honorable  and  reliable. 

Do  not  deter  your  patients  from  patronizing  a  pharmacist 
simply  because  he  is  also  a  graduate  in  medicine,  unless  he  be 
uniting  the  two  callings  from  mercenary  motives,  or  habitually 
prescribe,  or  have  a  drug-store  (with  a  window  full  of  bottles  of 
colored  water  and  quack  placards)  merely  as  a  stepping-stone  to 
get  acquaintances  and  an  introduction  preliminary  to  making  his 
(febut  as  your  antagonist  or  rival ;  or  if  you  fold  your  arms  and 
allow  your  prescriptions  to  be  compounded  by  a  drug-store  phv- 
sician  who  prescribes  over  his  counter,  or  in  office  or  parlor,  free 
of  charge,  and  makes  it  up  on  the  medicine  ordered,  you  will, 
unless  he  shows  less  than  the  usual  amount  of  selfishness,  be 
apt  finally  to  regret  it. 

Independently  of  all  other  considerations,  the  joint  prac- 

(259) 


260  THE   PHYSICIAN    HIMSELF: 

tice  of  scientific  pharmacy  and  modern  medicine  is  too  much  for 
the  grasp  of  any  one  human  intellect,  and  a  person  needs  all  his 
time  to  do  justice  to  either,  else  one  or  the  other  is  apt  to  be 
slighted ;  and  if  your  prescription  fall  into  the  hands  of  such 
parties,  or  be  left  to  their  apprentices  or  assistants,  both  you  and 
your  patient  must  take  a  great  many  risks. 

There  is  not  the  slightest  wrong  in  having  your  name 
printed  on  your  prescription  blanks.  But  do  not  use  a  prescrip- 
tion paper  which  has  any  other  name  upon  it  besides  your  own. 
If  it  contain  the  name  of  a  neighboring  pharmacist,  it  will  natu- 
rally suggest  collusion  or  something  else  not  complimentary ;  if 
it  contain  some  enterprising  fellow's  commercial  puff,  it  will 
indicate  very  ordinary  taste  for  you  to  use  it.  It  is  probably 
better  to  write  on  good,  plain  paper  ;  although  it  could  do  no 
harm  to  have  some  such  truthful  phrase  as  the  following  printed 
on  the  back  of  each  prescription  blank,  for  the  benefit  of  the 
public  and  the  protection  of  your  own  interests :  "  A  remedy 
that  is  useful  for  a  patient  at  one  time  may  be  improper  for  the 
same  patient  at  another  time,  or  for  other  persons  at  any  time, 
even  though  suffering  with  a  similar  affection." 

Plain  white-paper  clippings  suitable  for  prescription  blanks 
can  be  purchased  cheaply  at  any  printing-office  or  book-bindery, 
or  you  can  buy  a  ream  of  suitable  paper  from  wholesale  paper 
dealers,  who  will  cut  it  into  any  size  you  wish. 

It  would  be  wrong,  very  ivrong,  to  work  hand-in-hand  with 
a  pharmacist,  and  receive  from  him  a  percentage  on  your  pre- 
scriptions for  sending  them  to  his  store,  and  for  this  reason : 
were  you  to  accept  part,  it  would  be  robbing  either  the  pharma- 
cist or  the  patient.  Were  the  former  to  allow  you  so  much  for 
each  prescription,  and  re-imburse  himself  by  adding  the  extra 
amount  to  the  sum  charged  the  patient  for  the  remedy,  it  could 
not  be  looked  upon  in  any  other  light  than  that  you  had  com- 
bined to  fleece  an  extra  amount  from  every  unfortunate  who 
trusted  to  your  honor,  just  as  one  would  look  upon  a  lawyer 
who  took  fees  from  both  sides.     On  the  other  hand,  if  the  phar- 


HIS   REPUTATION    AND    SUCCESS.  261 

macist  possessed  more  honesty  than  you  and  allowed  you  to 
reduce  his  legitimate  profit,  because  compelled  to  do  so  or  lose 
your  influence,  it  would  place  you  in  a  most  contemptible  po- 
sition, and  you  would  live  in  constant  danger  of  exposure  and  a 
public  condemnation  that  the  strength  of  Hercules  could  not, 
and  the  God  of  Justice  would  not,  silence. 

Honesty  is  the  true  keystone,  without  which  the  whole  arch 
of  honor  falls. 

"If  I  lose  my  honor  I  lose  myself!" 

You  must  live,  and  must  have  fees  to  enable  you  to  do  so, 
but,  unless  you  obtain  every  dollar  and  every  dime  honestly  and 
honorably,  you  cannot  escape  the  finger  of  scorn ;  therefore, 
watch  zealously  that  the  public  do  not  imbibe  a  belief  that  you 
are  a  part  owner  of  or  are  interested  in  the  loaves  and  fishes 
of  the  drug-store  which  compounds  the  largest  number  of  your 
prescriptions.  If  such  a  suspicion  be  expressed  by  any  one,  or 
if  any  one  insinuate  that  you  seem  to  prescribe  for  the  purse 
of  the  pharmacist  rather  than  for  the  health  of  the  patient,  take 
care  to  inform  him  that  you  have  no  such  interest. 

If  any  pharmacist  volunteer  to  supply  a  physician  and 
his  immediate  family  with  medicines  either  free  or  at  a  nominal 
price,  or  with  such  proprietary  or  other  articles  as  he  needs,  at 
cost,  the  favor  can  be  conscientiously  accepted,  but  it  would  be 
unjust  to  allow  him  to  supply  uncles,  aunts,  and  cousins  on 
similar  terms.  Bear  in  mind  that  such  a  course  naturally  entails 
more  or  less  obligation  or  reciprocal  professional  attendance  on 
the  pharmacist  and  his  family,  and  should  be  taken  into  con- 
sideration when  accepting  favors. 

Duty,  alike  to  yourself,  your  patients,  and  the  profession, 
forbids  you  to  supply  one  or  several  pharmacists  with  private 
marks,  technical  terms,  or  hieroglyphic  symbols  that  other  phar- 
macists cannot  understand,  as  it  would  at  once  suggest  trickery 
and  corrupt  motives.  A  still  meaner  (swindling)  device  would 
be  to  have  a  secret  or  cabalistic  code,  for  use  between  physician 
and  pharmacist,  intelligible  to  them  alone.     Surely,  neither  you 


262  THE    THYSICIAN    HIMSELF  I 

nor  any  other  honest  person  needs  warning-  against  such  abuses 
as  these,  for  any  one  wlio  would  resort  to  ])rivate  codes  or  cipher 
prescriptions  lor  money-getting  is  neither  honorable  nor  honest, 
and  might  very  properly  be  classed  with  the  vulture  who  re- 
joices at  sickness,  and  the  wretch  who  desires  the  epidemic.  The 
trail  of  the  serpent  is  over  them  all ;  knaves — 

"Whom  none  can  love,  whom  none  can  thank, 
Creation's  blot,  creation's  blank." 

Your  prescription  is  intended  simply  to  tell  the  pharmacist 
what  medicine  you  wish  the  patient  to  receive.  When  sent  to 
the  pharmacist  it  is  an  order  for  a  certain  medicine  prepared  in 
a  certain  way.  The  law  has  decided  that  this  prescription  or 
order  belongs  to  the  patient ;  the  pharmacist,  after  compound- 
ing it,  has,  however,  a  natural  right  to  retain  it  as  his  voucher, 
but  he  has  no  right  to  refill  your  order  without  your  consent. 

The  unauthorized  refilling  of  prescriptions  by  pharmacists 
has  often  produced  the  opium,  alcohol,  cocaine,  chloral,  and 
other  enslaving  habits.  We  also  well  know  that  it  is  often 
unsafe  for  a  person  to  take  a  medicine  ordered  for  another, 
or  even  the  same  medicine  at  different  times.  Furthermore, 
how  can  the  pharmacist  conscientiously  label  the  second  quan- 
tity, "  Take  as  directed  by  Dr.  Faraway,"  when  Dr.  Faraway  is 
not  even  aware  of  the  refilling  1 

In  consequence  of  the  present  unfair  habit  of  many  phar- 
macists, the  unauthorized  refilled  prescriptions  probably  out- 
number those  of  the  authorized,  five  to  one. 

Drug-stores  have  become  so  numerous  of  late,  and  the  area 
from  which  each  must  derive  its  patronage  and  support  is  so 
limited,  that  their  proprietors,  in  order  to  keep  their  heads 
above  water,  have  either  to  charge  very  high  for  the  medicines 
prescribed  or  substitute  inferior  drugs ;  the  result  is  that  drug- 
bills  have  gradually  grown  greater  and  greater,  till  of  late  they 
almost  eclipse  the  charges  for  medical  attendance.  Many  people, 
to  avoid  what  appear  to  them  exorbitant  prices,  now  actually 
buy  this,  that,  or  the  other  quack  medicine,  make  home  mix- 


HIS   REPUTATION    AND    SUCCESS.  263 

tures,  wend  their  way  to  no-drug  irregulars  or  some  over-the- 
counter-prescribing  druggist,  or  trust  entirely  to  nature,  instead 
of  paying  physicians  for  prescriptions  and  then  having  to  pay 
heavily  to  have  them  compounded. 

The  cost  of  medicines  may  be  slightly  reduced  by  instruct- 
ing your  patient  to  save  the  cost  of  the  bottle  by  carrying  one 
with  the  prescription  ;  doing  so  cannot  be  objectionable  to  phar- 
macists, as  they  charge  only  cost  price  for  bottles.  A  good  and 
legitimate  way  to  lessen  the  cost  of  certain  prescriptions  is  to 
omit  inert  and  unessential  ingredients  ;  for  example,  if  you  pre- 
scribe a  mixture  of  wine  of  colchicum-root,  tincture  of  digitalis, 
.and  sulphate  of  morphia  for  a  patient,  do  not  increase  what 
would  naturally  be  a  one-ounce  mixture,  that  would  cost  about 
thirty-five  cents,  into  six  or  eight  ounces,  by  adding  syrup, 
water,  or  other  vehicle,  thus  swelling  the  dose  to  a  tablespoon- 
ful  and  the  cost  to  a  dollar.  Prescribe  the  essential  ingredients 
only,  and  let  the  directions  specify  how  many  drops  to  take  and 
how  and  when. 

A  dose  of  medicine  in  powder  or  pill  form  is  usually  more 
expensive  than  the  same  in  fluid  form ;  besides,  poisons  and 
very  active  remedies  can  be  more  accurately  divided  when  in 
solution. 

Another  evil  resulting  from  there  being  too  many  pharma- 
cists for  all  to  live  by  legitimate  business  is,  that  not  a  few,  not 
content  with  the  great  '■'■apothecaries^  profit "  derived  from  the 
sale  of  medicines,  encroach  on  the  domain  of  medical  practice, 
and  prescribe,  by  the  smattering  of  knowledge  they  pick  up 
from  the  prescriptions  of  competent  physicians,  for  every  foolish 
applicant  whose  case  does  not  appear  to  be  formidable ;  even 
selling,  by  guess-work,  this,  that,  or  the  other  thing  for  liome 
cases  which  they  have  not  even  seen,  because  asked  to  do  so  b^ 
the  foolish ;  and  thus  build  up  a  large  office  (or  store)  practice. 
How  many,  how  very  many,  simple,  functional  cases  are  thus 
given  medicines  which  do  no  good,  but  great  harm,  by  taking 
the  place  of  others  which  might  have  been  of  great  benefit  if 


264  THE    PHYSICIAN    HIMSELF: 

given  at  the  proper  time,  and  are  in  tliis  way,  during  the  first 
few  hours  or  days,  converted  into  incurable  or  organic  ones  by 
such  "  medicine-men " ;  and  how  many  new  ailments  are 
induced  by  Mr.  Emetic's,  Mr.  Gargle's,  and  Mr.  Jackall's  hap- 
hazard prescribing  heaven  only  knows.  Fully  one-half  of  all 
cases  of  venereal  disease,  biliousness,  debility,  cough,  and  the 
like,  are  now  seen  and  treated  by  pharmacists  (and  their  clerks 
and  greenhorn  apprentices)  before  calling  on  physicians.  Four 
out  of  five  of  those  whose  complaints  prove  simple  are,  of 
course,  cured  like  magic  by  the  four  little  pills  which  the  phar- 
macist recommends,  or  by  the  great  liniment  he  sells,  or  by  his 
noted  fever-and-ague  mixture  or  equally  famous  tonic,  or  his 
universal  elixir,  that  is  simple  and  caii't  do  any  harm,  etc. ;  and 
they,  thinking  that  he  has  turned  some  dire  disease  aside,  laud 
the  pharmacist  to  the  skies  and  advise  all  to  go — 

"Fools  go  in  throngs  " — 

to  Him  for  their  livers,  and  kidneys,  and  lungs,  and  brains,  and 
stomachs,  instead  of  consulting  a  legitimate  physician,  with 
assurances  that  He  is  as  good  as  any  doctor,  and  a  great  deal 
cheaper. 

Hear  Shelley  in  his  scenes  from  the  "  Chalderon  Dia- 
logue " : — 

"  Cf/.     Have  you  studied  much  ? 

"  De.  No :  and  yet  I  know  enough  not  to  be  wholly 
ignorant. 

"  Cy.     Pray,  Sir,  w^hat  sciences  may  you  know  1 

"  De.     Many. 

"  Ci/.  Alas !  much  pains  must  we  expend  on  one  alone, 
and  even  then  attain  it  not ;  but  you  have  the  presumption  to 
assert  that  you  know  many  without  study. 

"  De.  And  with  truth,  for  in  the  country  whence  I  come 
sciences  require  no  learning  ;    they  are  known. 

"  Cy.  Oh  !  would  I  were  of  tliat  bright  country  !  for  in 
this  the  more  we  study  we  the  more  discover  our  great  igno- 
rance." 


HIS    REPUTATION    AND    SUCCESS.  265 

No  person  who  is  incompetent  to  examine  a  patient  is  com- 
petent to  prescribe  for  him;  and  I  would  ask  what  sensible 
pharmacist  would  trust  himself,  or  his  wife,  or  his  cliild  to  the 
examination  and  "  subscriptions  "  of  a  neighboring  pharmacist  ] 

Another,  although  lesser,  evil  is  this :  If  a  patient's  better 
sense  carries  him,  in  the  first  place,  to  a  physician  for  advice, 
instead  of  to  a  pharmacist,  ten  to  one  he  will  be  presented  at 
the  drug-store  with  one  or  two  quack  almanacs  filled  with 
infamous  and  alarming  falsehoods,  or  a  handful  of  advertising- 
pictures,  or  that  the  bottle  of  medicine  will  be  wrapped  in 
Foolembad's  or  some  other  pushing  fellow's  handbill.  The 
co-operation  of  the  pharmacist  as  retailing  agent  for  quack 
medicines  is  indispensable  to  quackery ;  and  without  it  seven- 
eighths  of  the  harm  that  patent-medicine  literature  is  doing 
would  cease,  the  vain  promises  that  keep  the  public  rushing 
from  one  lying  wonder  to  another  would  no  longer  entice,  and 
at  least  two-thirds  of  the  quack  and  humbugging  proprietary 
trash  that  now  curses  our  land  would  slink  from  sight. 

"Oh,  where  is  the  still,  small  voice  of  conscience?" 

You  will  do  well  to  avoid,  as  far  as  possible,  all  pharma- 
cists whose  presumption  leads  them  to  assume  the  role  of  a 
physician.  The  recommendation  does  not,  of  course,  refer  to 
emergencies,  in  which  a  pharmacist  acts  as  a  humanitarian. 
The  manufacture  of  steel  is  one  thing,  and  applying  watch- 
springs  is  another.  Medicines  are  the  physician's  two-edged 
tools ;  a  pharmacist  may  prepare  them  and  handle  them  for  a 
life-time  and  be  an  excellent  compounder,  and  yet,  as  his  studies 
are  pharmaceutical  and  not  therapeutical,  he  may  know  no 
more  about  prescribing  for  the  sick  properly  than  the  mechanic 
who  makes  needles  or  scissors  does  about  dressmaking ;  or  the 
instrument-maker  does  about  operative  surgery ;  or  the  manu- 
facturer of  trowels  and  plows  and  chisels  about  bricklaying, 
farming,  or  carpentering. 

If  a  sick  person  ask  a  pharmacist  for  a  plaster,  a  dose  of 
cathartic   pills,  or  an  ounce  of  tincture  of  iron,  there   is   no 


266  THE    PHYSICIAN    HIMSELF: 

reason  why  he  should  refuse  to  sell  them ;  but  if  he  ask  him 
what  is  the  best  remedy  for  this,  that,  or  his  other  affliction, 
with  a  view  to  purchase  whatever  he  designates,  that  is  another, 
a  therapeutical  matter,  and  is  beyond  his  sphere. 

"Michael,  Michael,  you  have  no  bees,  and  yet  you  sell  honey." 

Be  also  on  your  guard  against  instrument-makers  and 
dealers  who  meddle  with  surgical  cases,  and  manufacturers  of 
appliances  for  deformities,  examining  or  prescribing  opticians, 
masseurs,  etc.,  who  presume  to  treat  cases  tliat  should  be  referred 
to  the  physician  or  surgeon.  In  fact,  avoid  encouraging  any 
one  who  encroaches  on  the  physician's  province. 

Every  patient  should  be  warned  that  it  is  dangerous  to 
wear  spectacles,  trusses,  supporters,  braces,  pessaries,  and  the 
like,  that  have  not  been  prescribed  by  a  physician. 

Make  it  a  point  never  to  style  a  pharmacist,  an  optician,  a 
preacher,  or  any  one  else,  "  Doctor,"  or  "  Professor,"  unless  he  he 
one.  Heaven  knows  the  much-abused  titles  are  cheap  and  pro- 
miscuous enough  without  bestowing  them  on  ignorant  spectacle- 
pedlers,  and  others  who  have  not  even  applied  for  them. 

Avoid  overpraising  any  prescribing  pharmacist  to  your 
patients,  or  people  will,  on  your  word,  overestimate  him,  and 
begin  to  rely  on  his  gratuitous  advice,  instead  of  on  the  phy- 
sician's, in  all  cases  considered  moderate. 

Bevi^are  of  pharmacists  who  indiscreetly  talk  too  freely,  or 
converse,  joke,  etc.,  while  compounding  prescriptions,  or  know- 
ingly insinuate  to  those  who  carry  them  prescriptions  that  they 
know  what  they  are  for,  and  have  extra  impudence  when 
cubebs,  ergot,  etc.,  are  ordered ;  or  suggest  to  purchasers  that 
the  dose  prescribed  is  too  large  or  too  small ;  also,  the  blunder- 
ing blockheads  who  misread  prescriptions  or  miscopy  directions, 
or  put  wrong  directions  or  the  wrong  physician's  name  on 
bottles,  or  surprise  and  alarm  people  by  charging  a  different 
price  every  time  a  prescription  is  renewed,  as  if  they  had  no 
system,  or  as  if  the  medicines  were  put  up  wrong ;  who  make 
the  impression  that  it  takes  them  half  their  time  to  correct  the 


HIS   REPUTATION   AND    SUCCESS.  267 

blunders  and  mistakes  of  the  other  half;  who  leave  prescrip- 
tions partly  compounded  to  wait  on  other  customers,  or  to 
unscrew  soda-water  for  sports  who  are  in  a  hurry;  or  who  in 
other  ways  allow  interruption,  or  show  abstraction  or  careless 
compounding.  For  such  people  be  especially  careful  how  you 
abbreviate,  and  how  you  make  your  S's  and  5's,  and  carefully 
dot  every  i  and  cross  every  t  in  your  prescriptions,  so  as  to 
afford  them  no  shelter  if  a  mistake  occur,  and,  above  all,  to 
prevent  a  coroner's  jury ;  or  to  clear  yourself  if  a  death- 
certificate  is  made  necessary. 

Mistakes  in  writing  and  in  compounding-  prescriptions 
occur  more  often  from  improper  haste,  and  by  trying  to  do  two 
or  three  things  at  once,  than  from  incompetency. 

Prescriptions  written  with  ink  instead  of  pencil  have  the 
decided  advantage  that  they  are  not  easily  defaced  and  do  not 
admit  of  easy  erasure,  etc. 

A  very  good  and  safe  rule  in  prescription-writing  is  to  put 
down  all  the  ingredients  first ;  next  write  the  directions  to  the 
pharmacist  and  the  directions  for  use ;  then  the  number  of 
doses  should  be  decided  on,  and,  lastly,  the  quantity  of  each 
ingredient  should  be  carefully  calculated  and  carefully  written, 
followed  by  your  name  or  initials. 

Look  on  the  back  of  every  prescription  paper  you  use 
to  see  that  there  is  nothing  of  a  mistake-causing  nature 
accidentally  written  on  it. 

If  you  believe  on  good  authority  that  any  pliarmacist  so 
far  forgets  himself  as  to  make  disparaging  comments  upon  you, 
or  your  professional  ability,  or  your  remedies,  doses,  or  apparent 
inconsistencies  ;  or  to  exhibit  and  decry  your  prescriptions  to 
Irregulars,  laymen,  or  other  physicians,  or  to  predict  that  they 
will  not  prove  useful ;  or  to  make  unauthorized  substitutions, 
give  under-weight  of  expensive  ingredients,  or  omit  them  alto- 
gether,— 

"Who  knows  the  right,  and  yet  the  wrong  pursues," — 

or  to  join  with  our  enemies  in  reviling  our  profession  and  its 


268  THE    PHYSICIAN    HIMSELF: 

imperfections,  or  in  nick-naming  different  physicians  in  derision  ; 
or  to  keep  liis  prescription-file  open  to  miscellaneous  inspection, 
or  to  liave  a  medical  protege  under  his  wing,  into  whose  hands 
lie  endeavors  to  direct  customers  for  selfish  purposes,  or  to  be 
guilty  of  any  other  grossly  unprofessional  conduct,  you  will  be 
fully  justified  in  directing  your  patients  to  go  elsewhere  for 
medicines. 

In  ordering  syringes,  brushes,  atomizers,  breast-pumps,  pro- 
bangs,  etc.,  with  your  prescriptions,  be  careful  to  specify  the 
kind  or  size  you  wish.  To  write  a  prescription  for  a  solution, 
and  add,  "  also  a  syringe  for  using,"  is  often  as  perplexing  to 
the  pharmacist  as  if  you  were  to  send  for  a  slip  of  adhesive 
plaster  as  long  as  a  string  or  for  a  lump  of  rhubarb  the  size  of 
a  piece  of  chalk. 

When  any  one  is  unable  to  pay  the  full  price  for  what  you 
prescribe,  the  words  "  Poor  patient "  in  your  handwriting,  at  the 
top  of  the  prescription,  will  secure  from  any  pharmacist  the 
greatest  reduction  in  price  that  he  can  afford  to  make. 

You  may  take  the  following  as  somewhat  of  a  guide  in 
determining  whether  this  or  that  pharmacy  is  conducted  on  a 
proper  plane  and  worthy  of  confidence.  Among  the  dis- 
tinguishing features  of  a  legitimate  and  properly  conducted 
pharmacy  are : — 

1.  Proprietor  an  experienced  practical  pharmacist,  of  intel- 
ligence, capacity,  and  integrity. 

2.  Competent  and  courteous  assistants. 

3.  Pride  and  skill  shown  in  selecting  and  preparing  pure 
medicines. 

4.  Prescriptions  compounded  only  by  graduates  in  phar- 
macy. 

5.  A  full  and  comprehensive  line  of  pure  drugs,  apparatus 
and  appliances  for  use  in  the  care  of  the  sick,  also  dietetics  and 
sick-room  conveniences  kept. 

6.  An  orderly  and  perfectly  equipped  prescription  depart- 
ment.    Store  neat  and  attractive. 


HIS   REPUTATION    AND    SUCCESS.  269 

7.  Quiet   and   discipline    maintained.      No   loungers    or 
smokers. 

8.  No  liquors  sold  as  beverages. 

9.  Not  a  bazaar  of  general  merchandise. 

10.  Patent  medicines  and  other  nostrums  shown  and  sold 
only  when  called  for. 

11.  No  habitual  prescribing  or  giving  medical  advice. 

12.  Prices  neither  cheap  nor  exorbitant,  but  reasonable. 

13.  Prompt  attention  and  accuracy  characteristic. 
Among  the  features  that  mark  improperly  conducted  ones 

aife; — 

1.  Habitual  prescribing  over  the  counter. 

2  Indiscriminate  refilling  of  prescriptions. 

3.  Unnecessary  delay  and  detention  of  customers. 

4.  Careless  handling  of  medicines  and  loose  management 
of  store. 

5.  Patent  and  proprietary  remedies  paraded  and  pushed. 

6.  Disparagement  of  physicians  to  the  laity. 

7.  Store  a  resort  for  political  or  other  crowds  or  cliques. 

8.  Unchaste  conversations  and  disreputable  conduct. 

9.  Wines  and  liquors  sold  as  beverages. 

10.  Dealing  in  articles  used  for  criminal  or  immoral  pur- 
poses. 

11.  Engrossing  attention  to  sale  of  soda-water,  cigars, 
tobacco,  fancy  goods,  etc. 

12.  Store  kept  merely  as  an  adjunct  to  some  other  project. 

13.  Lack  of  sobriety  in  proprietor  or  clerks. 

*  *  41: 

Be  prompt  and  decided  in  refusing  to  give  laudatory  pro- 
fessional certificates  to  any  secret  article;  do  not  be  too  liberal 
even  in  giving  them  to  legitimate  pharmaceuticals,  and  never 
issue  one  founded  on  any  other  basis  than  purity  of  ingredients, 
or  special  skill  or  experience  in  compounding  them. 

Willingness  to  give  medical  certificates  is  an  almost  uni- 
versal weakness  of  mankind.     The  idea  of  being  paraded  in 


270  THE    PHYSICIAN    HIMSELF: 

print  as  "  an  authority  "  in  connection  with  some  wonderful 
cure  is  pleasing  to  thousands  of  people  in  every  station  of  life, 
and  makes  them  willing  to  have  their  names  and  even  their 
pictures  paraded  in  almanacs,  hand-bills,  and  newspapers.  In- 
deed, many  impressible  people,  whose  bump  of  wonder  is  easily 
touched,  could  almost  be  inveigled  into  certifying  in  medical 
matters  that  two  and  two  make  five  by  any  sharper  wlio 
understands  how  to  tickle  their  self-conceit  and  love  of 
notoriety. 

Be  alike  determined  in  declining  to  give  (un)professional 
certificates  to  any  one  on  disputed  or  partisan  questions,  or 'in 
regard  to  surgical  appliances,  copyrighted  medicines,  rival  wines, 
competing  mineral  waters,  beef-extracts,  baking  powders,  arti- 
cles of  commerce,  patent  contrivances,  health  resorts,  etc.,  for 
they  are  often  improperly  used  and  made  subservient  to  pur- 
poses not  anticipated,  and  will  affect  the  interests  of  the  profes- 
sion at  large,  as  well  as  your  own.  If  you  ever  give  one, 
people  who  happen  to  know  you  may  regard  its  personal  and 
not  its  professional  significance,  but  every  one  else  throughout 
the  land  will  know  your  title  only.  When  amiable  John  Doe 
gives  his  certified  opinion  that  ice  is  hot  and  fire  is  cold,,  it 
remains  simply  John  Doe's  opinion ;  but  when  John  suffixes  his 
title  of  M.D.,  he  undoubtedly  gives  that  certificate  a  profes- 
sional significance,  and,  to  some  extent,  involves  the  entire 
profession  therein. 

You  may  judge  certificate-giving  by  its  prejudicial  effiects 
on  our  own  profession.  One  of  the  worst  inflictions  we  endure 
to-day  is  the  endless  parade  of  misleading  certificates  from  wide- 
mouthed  clergymen,  politicians,  merchants,  lawyers,  D.D.s, 
LL.D.s  (A.S.S.s,  N.G.s),  and  other  "distinguished  citizens," 
known  and  unknown,  recommending  all  kinds  of  medical 
nostrums. 

"Heigh  ho,  the  devil  must  be  dead." 

You  know,  and  every  sensible  person  knows,  that  such  Peck- 
sniffian  certificates  are  not  worthy  of  credence,  and  that  the 


HIS   REPUTATION    AND    SUCCESS.  271 

preacher  of  Gospel  truth  who  (instead  of  confining  himself  to 
preaching  the  Glorious  undefiled  Gospel  of  the  blessed  God,  the 
God  of  the  Bible),  bribed  by  a  box  of  pills,  or  a  bottle  of  bit- 
ters (that  make  drunkards  and  kill  forty  times  as  quick  as 
whisky  does),  forgets  his  high  mission,  the  cure  of  dying  and 
perishing  souls,  and  with  reverential  sanctimonious  solemnity 
(ahem !)  turns  up  the  whites  of  his  eyes, — 

"O  hollow,  hollow,  hollow  !" — 

and  lends  his  name  and  the  cloak  of  theology  to  assist  the 
Diabology  of  charlatans  and  sharpers  who  deceive  the  afflicted 
with  quack  nostrums  that  are  not  worth  the  cost  of  the  bottle 
they  are  in,  must  be  eitlier  a  silly  dupe  or  a  cruel  knave. 

"Knaves  and  fools  divide  the  world." 

Prof.  Brass,  Dr.  Skinem,  and  every  other  sharp  quack 
knows  the  influence  of  a  clergyman's  religio-medical  indorse- 
ment published  in  a  Sunday  paper,  and  hence  makes  special  and 
too  often  successful  efforts  to  obtain  it,  feeling  certain  that  thev 
can  easily  entrap  the  dupable  portion  of  the  flock  after  the 
Shepherd  (?)  is  secured, — 

"He  steers  his  boat  well," — 

and  it  is  a  singular  fact  that,  though  few  men  get  more  gratui- 
tous advice  out  of  physicians  than  ministers  of  the  Gospel,  yet 
no  class  do  more  to  injure  the  profession,  by  the  ridiculous 
countenance  they  give  to  various  kinds  of  quackery  and  pathies 
and  isms.     Truth  should  teach  teachers  to  teach  truth. 

Suppose  it  suited  the  pride  and  the  principles  of  our  pro- 
fession to  enter  the  self-advertising  arena,  with  quacks  and 
patent-medicine  men,  and  to  scatter  reports  of  all  our  daily  cures 
and  successes  all  over  the  land !  Where  would  the  petty 
triumphs  of  quackery,  and  patent  pills,  and  bottled  nostrums 
stand  in  the  contest?  Austin  Flint  vs.  Hostetter;  Samuel  D. 
Gross  vs.  Brandeth,  Johns  Hopkins  Hospital  vs.  Keeley's. 

Whenever  you  are  asked  by  traders  in  medicine,  or  their 
plausible  drummers,  who  have  no   further  interest  in  sickness 


272  THE    PHYSICIAN    HIMSELF  I 

than  as  it  advances  the  sale  of  their  nostrnms  ;  and  when  tempted 
by  glowing  advertisements,  highly-colored  certificates,  epitomized 
treatises  on  therapeutics  and  practice,  etc.,  to  prescribe  and  make 
a  market  for  their  semi-secret  trade-mark  pharmaceuticals,  copy- 
righted medicines,  and  the  nine  hundred  and  ninety-nine 
elixirs,  restoratives,  tonics,  panaceas,  and  other  specialties  "with 
attractive  empirical  names,  gotten  up  by  middlemen,  crusad- 
ing druggists,  manufacturing  pharmacists,  and  pharmaceutical 
associations,  with  labels  that  give  suggestions  for  their  use,  to 
catch  the  popular  eye  and  the  popular  dollar — think  of  the  cun- 
ning cuckoo  (see  p.  32),  and  how  its  one  eg^  hatches  evil  to  the 
whole  nest,  and  do  not  use  them.  Patent  medicines  are  wolves 
in  wolves'  clothing ;  proprietary  medicines  are  wolves  in  sheep's 
clothing,  whose  owners  are  begging  favors  from  you  with  one 
hand  and  intercepting  your  patients  with  the  other. 

To  fully  realize  the  colossal  proportions  of  the  lucrative 
proprietary  remedy  method  of  superseding  physicians,  and  of 
the  mercenary  motives  and  humbuggery  that  lie  at  the  bottom 
of  it,  and  the  injury  it  inflicts  on  health,  credit,  and  business,  go 
and  take  a  bird's-eye  view  of  the  vast  and  bewildering  array  of 
empirical  and  proprietary  compounds:  syrups,  balsams,  expec- 
torants, and  panaceas,  each  good  for  everything, — asthma  and 
sore  eyes,  the  itch  and  worms;  and  at  tlie  bushels  of  recom- 
mendations under  which  the  shelves  in  the  quack  and  proprie- 
tary departments  of  every  wholesale  drug-store  groan,  and  tlien 
reflect  on  the  enormous  sums  of  money  spent  in  telling — 

Quack  !     Quack  !  !     Quack  !  !  !— 

of  their  virtues  in  the  newspapers,  and  on  rocks,  fences,  and 
dead  walls.  Thus  enlightened,  you  can  hardly  fail  firmly  to 
resolve  henceforth  to  abjure  them. 

"The  path  of  duty  is  the  path  of  safety." 

Unless  you  have  mistaken  your  profession,  are  incapable 
of  thinking  and  lack  ingenuity,  our  standard  and  accepted 
agents,  the  United  States  Pharmacopoeia  and  the  dispensatories, 


HIS   REPUTATION    AND    SUCCESS.  273 

should  certainly  be  large  enough  and  reliable  enough  to  allow 
you  to  exercise  yourself  freely  in  the  art  of  prescribing,  and  to 
make  any  required  combination,  and  to  accurately  adjust  the 
relative  proportion  of  every  ingredient  to  the  condition  of  your 
patient ;  and  you  should,  therefore,  assert  your  intelligence  and 
follow  this,  the  legitimate  mode  of  prescribing,  and  let  our  com- 
mercial rival's  ready-made  novelties,  patented  articles,  and  dish- 
water substitutes  for  medical  attendance  alone. 

Of  course,  if  anything  truly  useful  or  unmistakably  better 
than  the  old  is  discovered,  but  not  yet  in  the  pharmacopoeia, 
you  would  not,  you  sliould  not  fail  at  once  to  give  your  patient 
the  benefit  of  it ;  but  beware  of  all  articles  that  are  being  adver- 
tised and  pushed  on  catchpenny  principles. 

The  principle  which  governs  our  condemnation  of  secret 
nostrums  is  this :  They  not  only  do  more  harm  than  good,  but, 
if  puffing  and  advertising  alone  enable  the  proprietor  of  a 
quack  remedy  to  fleece  the  sick,  its  unprincipled  owner  deserves 
exposure  and  contempt.  If  the  nostrum  is  really  valuable, 
which  is  very  rarely  the  case^  its  composition  should  be  freely 
and  fully  disclosed  for  the  benefit  of  suffering  humanity. 

You  should  also  maintain  your  independence  and  never 
order  A.'s,  B.'s,  or  C.'s  make  of  anything  unless  you  have  some 
specific  therapeutical  reason  for  so  doing.  To  thus  particularize 
would  not  only  reflect  injuriously  on  every  other  manufacturer 
and  cause  a  still  greater  popular  distrust  of  our  materia  medica 
and  pharmacopoeia,  but  also  put  the  compounder  to  additional 
trouble  and  expense ;  for  he  might  have  several  other  varieties 
of  the  same  article  in  his  stock,  and  yet  be  compelled  by  your 
specification  to  get  another.  It  almost  invites  substitution.  I 
knew  one  case  in  which  the  pharmacist,  though  he  had  twenty-one 
different  preparations  of  codliver-oil  emulsions,  resembling  each 
other  so  closely  in  all  important  respects  that  but  a  hair  divided 
them,  standing  spoiling  on  his  shelves,  had  to  get  the  twenty- 
second  to  fill  such  a  prescription. 

Do   not,  however,  0})pose    any  remedial    agent   that  is  a 


274  THE    PHYSICIAN    HIMSELF: 

distinct  improvement  in  pharmacy,  or  any  particular  brand  of 
anything  on  account  of  its  being  a  monopoly,  if  that  monopoly 
is  owing  to  unusual  skill,  superior  quality  of  materials  used,  or 
great  perfection  in  its  manufacture. 

Patients  are  under  the  impression  that  pharmacists  have 
about  ninety  cents  profit  in  every  dollar,  and  also  think  phy- 
sicians know  precisely  what  a  medicine  ought  to  cost,  and  will 
often  ask  you  liow  much  the  druggist  will  charge  for  the  reme- 
dies you  have  prescribed.  Reply  promptly  that  you  do  not 
know,  that  some  medicines  cost  the  pharmacist  twenty  times  as 
much  as  others,  and  avoid  mentioning  any  specific  sum ; 
because,  were  you  to  guess  too  high,  they  might  infer  that  he 
had  either  made  a  mistake  or  used  inferior  drugs  ;  and  were  you 
to  guess  too  low,  they  would  probably  accuse  the  pharmacist  of 
overcharging,  and  perhaps  drag  your  name  into  their  squabbles. 
Further,  the  people  naturally  overlook  one  all-important,  price- 
less ingredient  that  every  good  pharmacist  employs  in  com- 
pounding prescriptions,  the  worth  of  which  he  justly  adds :  I 
mean,  the  concentrated  extract  of  brains. 

Whenever  you  prescribe  a  remedy  that  is  unusually  expen- 
sive, such  as  musk,  salicin,  resorcin,  salol,  oil  of  erigeron,  etc., 
take  care  to  inform  the  patient  of  the  fact,  and  that  expensive 
drugs  are  no  more  profitable  to  the  pharmacist  than  cheaper 
ones,  so  that  he  will  not  be  surprised  and  cavil  when  the  phar- 
mat^ist  tells  him  how  much  he  charges  for  it. 

Notice  particularly  whether  a  pharmacist  gives  unusual 
prominence  to  nostrums,  quack  almanacs  and  placards,  or  has 
quack  advertising  signs  painted  on  his  doors  or  outside  walls, 
and  it  will  give  you  a  true  insight  into  his  aims  and  attitude 
toward  our  profession.  If  you  see  that  he  is  pushing  his  quack 
department  in  a  hurrah  way,  with  quack  proprietors'  portraits 
in  his  windows  and  hanging  around  his  store, — 

"Roaring,  roaring,  roaring,  nothing  but  roaring," — 

and  his  own  name  and  influence  used  in  handbills  and  almanacs 
as  a  vendor  of  nostrums,  bitters,  plasters,  pads,  etc.,  or  selling 


HIS    REPUTATION    AND    SUCCESS.  275 

liquor  as  a  beverage,  or  selling-  medicines  at  retail  or  less  than 
his  pharmaceutical  neigh l)ors  pay  for  them  at  wholesale,  you  mav 
be  sure  that  he  is  conducting  his  establishment  simply  as  a  trades- 
man, on  a  trade  basis  rather  than  on  a  professional  one,  which 
latter  presumes  him  to  love  pharmacy  and  to  devote  his  chief 
attention  to  the  inspection  and  preparation  of  pure  and  reliable 
drugs,  and  compounding  prescriptions  with  scrupulous  exact- 
ness; and  by  shunning  him  you  will  fulfill  a  moral  obligation. 
To  sell  abortifacients,  or  vile  nostrums  intended  to  produce 
abortion,  with  the  pretended  caution,  "  Perfectly  harmless,  but 
not  to  be  taken  by  women  in  a  certain  condition,"  is  criminal. 

"  Cunning  has  but  little  honor." 

Probably  you  have  no  right  to  ask  or  expect  that  the  phar- 
macist should  not  deal  in  quack  or  proprietary  medicines,  or 
anything  else  for  which  there  is  a  demand,  as  he  keeps  his  store 
to  make  a  living ;  you  have,  however,  an  undoubted  right  ta 
expect  him  to  show  the  equity  of  his  position  between  their 
owners  and  us  by  keeping  them  out  of  sight,  to  be  shown  only 
when  called  for,  just  as  he  does  sweet  spirits  of  nitre,  syrup  of 
the  iodide  of  iron,  aromatic  spirits  of  ammonia,  and  other 
fruits  of  pharmaceutical  chemistry,  instead  of  pushing  their 
sale  by  displaying  their  announcements  far  more  prominently 
than  legitimate  pharmaceuticals. 

In  drugs  and  medicines  purity  and  accuracy  are  of  the  first 
importance,  because  the  uniformity  in  action  of  every  medicine 
is  in  proportion  to  its  purity  and  goodness ;  some  of  our  impor- 
tant remedies  vary  greatly  in  quality  and  in  strength,  and  this 
is  one  of  the  occasional  causes  of  uncertainty  in  the  practice 
of  medicine,  and  such  variability  would  modify  your  efforts  too 
much  to  be  risked  in  any  important  case.  A  badly  compounded 
prescription  may  rob  you  of  your  reputation  and  deprive  the 
patient  of  his  chances  of  recovery.  If  you  think,  therefore,  that 
an  important  prescription  is  likely  to  be  sent  to  a  pharmacist 
whom  you  conscientiously  believe  to  use  inferior,  stale,  or  impure 
articles,  it  is  your  duty  to  take  care  that  it  be  sent  elsewhere; 


276  THE    PHYSICIAN    HIMSELF. 

for,  being  responsible  for  the  patient's  welfare,  and  having  your 
own  reputation  to  care  for,  you  have  a  perfect  right,  and  indeed 
it  is  your  duty  under  such  circumstances,  to  have  your  remedies 
procured  where  you  believe  your  prescriptions  will  be  properly 
made  up. 

Pharmacy  requires  nice  and  delicate  skill  and  imposes  great 
responsibility,  and  the  art  of  medicine  is  imperfect  enough  at 
best,  and  you  will  encounter  more  than  enough  of  new  and 
strange  problems  to  remind  you  of  your  lack  of  aids  and  of  the 
insufficiency  of  human  resources,  without  adding  the  risk  of 
being  thwarted  by  the  error,  fraud,  or  accident  of  an  unreliable 
pharmacist  with  deteriorated,  adulterated,  or  inert  drugs ;  but 
when  you  find  it  necessary  to  ignore  any  one  for  this  reason, 
take  care  to  do  so  in  a  discreet,  ethical  manner,  with  as  little 
personality  as  possible. 

Whether  to  allow  a  patient  to  know  the  name  and  nature 
and  action  of  the  remedies  you  prescribe,  or  not,  requires  great 
discretion,  and  good  judgment  is  required  to  distinguish  between 
persons  who  would  and  those  who  would  not  be  benefited  by 
an  explanation  of  the  intended  remedies.  There  is  often  a 
temptation  to  endeavor  to  enlist  the  patient's  confidence  by  fur- 
nishing him  an  insight  into  the  nature  and  object  of  the  agents 
employed ;  but  the  majority  of  experienced  physicians  seldom 
commit  themselves,  or  if,  in  certain  cases,  to  gratify  the  patient's 
whims,  they  appear  to  >deld  to  the  temptation,  their  explana- 
tions are  advisedly  ambiguous,  and  you,  while  judiciously  seek- 
ing to  inspire  confidence  in  your  patients,  had  better  keep  them, 
as  far  as  may  be,  in  ignorance  of  the  remedies  employed.  But 
few  physicians  have  escaped  the  chagrin  of  seeing  their  reasons 
and  their  remedies  made  use  of  to  blame  them  and  to  cast  dis- 
credit on  their  skill.  You  will,  indeed,  often  wish  you  had 
synonyms  for  the  terms  quinia,  zinc,  opium,  chloral,  strychnia, 
morphia,  and  probably  for  other  articles  in  daily  use.  When- 
ever a  synonym  for  any  of  them  is  supplied,  it  will  be  judicious 
in  many  cases  to  use  it.     By  employing  the  terms  ac.  phenic. 


HIS   REPUTATION   AND    SUCCESS.  277 

for  carbolic  acid,  secale  corniit.  for  ergot,  kalium  for  potassium, 
natrum  for  sodium,  cliinin  for  quinia,  tinctura  thebaica  for  tinc- 
tura  opii,  etc.,  you  will  debar  many  a  patient  from  reading  your 
prescriptions  and  hampering  you, — a  check  which  is  often  highly 
desirable.  You  can  also  further  eclipse  his  wisdom  by  trans- 
posing the  terms  you  use  from  the  usual  order  and  writing  the 
adjective  in  full  and  abbreviating  the  noun, — e.g.,  instead  of 
writing  quiniae  sulpli.,  write  sulphatis  quin.;  compound  cathartic 
pills,  cath.  pil.  comp.,  etc.,  etc. 

The  official  pharmacopoeia  distinctly  recognizes  the  neces- 
sity of  concealing  the  nature  of  certain  preparations ;  and  opium 
may  be  ordered  under  several  synonyms  without  giving  the 
slightest  suspicion  of  its  presence.  You  cannot  greatly  err  in 
honestly  seeking  to  conceal  from  your  patients  the  nature  of  the 
remedies  prescribed  for  their  ailments. 

"The  silent  physician  has  many  advantages." 

Be  very  careful  to  have  all  powerful  remedies  intended  for 
external  use  labeled  "  For  external  use,"  or  "  Not  to  be  taken," 
which  will  not  only  tend  to  prevent  errors  and  misunderstand- 
ings, but  in  case  they  are  swallowed  by  mistake  it  will  save  you 
from  censure.  For  the  same  reasons,  also  be  careful  to  order 
all  mixtures,  that  may  separate  on  standing,  to  be  shaken 
before  pouring  out  the  dose,  otherwise  the  patient  may  get  all 
the  active  ingredients  in  either  the  first  few  or  the  last  few 
doses. 

When  you  prescribe  a  remedy  of  such  an  active  character 
that  it  would  poison  if  taken  in  large  doses,  or  all  at  once,  it  is 
wise  to  make  such  verbal  cautionary  remarks  about  it  as  will 
fully  put  those  who  administer  it  on  their  guard.  Also,  when 
you  prescribe  a  remedy  for  external  use,  and  at  the  same  time 
one  that  is  to  be  taken  internally,  be  careful  to  tell  the  patient 
how  each  will  look  and  smell,  so  that  he  may  not  confound 
them  and  swallow  the  wrong  one.  Absent-minded  pharmacists 
have  more  than  once  put  liniment  labels  on  bottles  containing 


278  THE    PHYSICIAN    HIMSELF: 

remedies  for  internal  use,  and  those  designed  for  the  latter  upon 
the  liniment-bottles,  thereby  leading  to  a  jury  of  inquest,  which 
a  word  of  explanation  from  the  physician  to  the  patient  might 
have  prevented. 

Pharmacists  might  easily  avoid  the  possibility  of  thus  ex- 
changing labels  by  compounding  one  and  labeling  it  before 
commencing  the  other.  By  instructing  the  pharmacist  to  put  a 
red  label  on  all  the  bottles  for  external  use,  security  against 
mistakes  is  better  insured. 

If,  in  prescribing  such  agents  as  tincture  of  belladonna  or 
tincture  of  iodine,  for  external  use,  you  direct  the  pharmacist  to 
"  put  brush  in  the  cork,"  seeing  the  brush  when  the  bottle  is 
opened,  will  almost  surely  prevent  its  being  taken  internally. 

You  will  notice  that  some  pharmacists  label  the  remedies 
they  compound  for  you  with  their  file  numbers  only,  thus,  7483  ; 
while  others  adopt  the  much  more  satisfactory  plan  of  adding 
the  date  on  which  it  was  compounded,  thus,  7483,  19-7-93, 
signifying  that  it  is  numbered  7483,  and  that  it  was  com- 
pounded July  19,  1893.  The  latter  plan  will  enable  you  to 
distinguish  between  the  dates  at  wliich  you  prescribed  different 
bottles  of  medicine,  and  may  otherwise  be  of  service  to  you.  I 
am  quite  sure  the  majority  of  pharmacists  would  cheerfully  make 
use  of  this  system  if  they  were  aware  how  often  it  assists  the 
physician. 

Even  with  the  best  care  every  one  is  liable  to  make  mis- 
takes, and  even  the  wisest  men  are  not  always  wise.  One  might 
write  tablespoonful  where  he  meant  teaspoonful,  or  sulph. 
morph.  instead  of  sulph.  quin.,  or  acid,  carbolic,  when  he  meant 
acid,  boracic,  or  tinct.  opii  when  he  meant  tinct.  opii  camph.,  etc. 

It  is  well,  therefore,  to  request  neighboring  pharmacists 
always  to  inform  you  of  any  ambiguity  or  apparent  mistake  in 
prescriptions  bearing  your  initials  before  dispensing  them,  and, 
in  return,  when 

"Some  one  has  blundered," 

and  you  have  reason  to  suspect  the  mistake  has  been  in  com- 


HIS    REPUTATION    AND    SUCCESS.  279 

pounding  the  prescription,  be  careful  not  to  make  your  suspicion 
known  either  by  word,  look,  or  action,  till  you  have  conferred 
with  the  person  who  dispensed  it.  The  error,  if  one  exist,  is 
just  as  apt  to  be  yours  as  his. 

When  a  prescription  is  for  an  infant,  or  a  young  child,  it  is 
a  great  safeguard  against  error  in  compounding  to  put  at  the 
head  of  the  prescription,  "  For  an  infant,"  or  "  For  a  child,"  or 
"  For  little  AVillie,"  etc. 

Bear  in  mind  that  the  pharmacist,  like  yourself,  is  only 
human,  with  long  hours  and  short  pay,  and  that  he,  like  other 
persons,  requires  some  rest  and  relaxation  from  his  drug-mixing 
and  drug-selling  slavery ;  and  do  not  order  mixtures  requiring 
tedious  manipulations,  or  direct  filthy  ointments  to  be  made,  or 
dirty  plasters  to  be  spread,  suppositories  to  be  molded,  or  other 
unpleasant  duties  to  be  performed  on  Sunday,  or  during  sleep- 
ing-hours, unless  they  be  urgently  needed. 


CHAPTER   XL 

"Sound  policy  is  never  at  variance  with  substantial  justice." 

As  a  physician  you  will  hold  two  positions  in  relation  to 
patients :  first,  during  sickness  you  will  feel  a  humane  interest 
in  them  and  a  scientific  interest  in  their  diseases,  give  them 
your  best  skill  and  your  labor,  and  employ  whatever  remedies 
will  be  most  surely,  most  safely,  and  most  raY)idly  beneficial ; 
to  this  you  will  add  sincere  sympathy  and  commiseration. 
Later,  when,  by  recovery  or  death,  your  interest  and  skill  are 
no  longer  required,  you  will  enter  upon  the  second,  or  business 
relation,  and  then  you  should,  unless  poverty  forbid,  demand 
and  secure,  in  a  business-like  manner,  a  just  remuneration  for 
your  services. 

Business  is  business,  and  should  always  be  regarded  as 
such.  You  must  be  clothed  and  fed,  and  must  support  those 
dependent  upon  you,  just  as  other  people  do.  Every  person 
naturally  and  properly  looks  to  whatever  occupation  he  follows 
for  support;  therefore,  let  not  false  delicacy  or  out-of-place 
politeness  break  up  the  business  part  of  your  profession,  or  inter- 
fere with  your  rules  in  money  matters,  or  prevent  your  knowing 
where  sentiment  ends  and  business  begins.  You  are  human, 
and  must  live  by  your  practice,  just  as  the  priest  lives  by  the 
altar,  the  lawyer  by  the  bar,  and  all  other  people  by  their 
avocations.  The  practice  of  medicine  is  the  work  of  your  life ; 
it  is  as  honest,  useful,  and  legitimate  a  branch  of  human  indus- 
try as  any  other  on  the  face  of  the  globe,  and  no  one  earns 
his  means  of  living  more  fairly,  and  often  more  dearly,  than 
the  hard-worked  physician,  and  both  common  sense  and  vital 
necessity  require  that  you  should  try  to  provide  properly  for 
yourself  and  for  those  dependent  on  your  labors  for  support. 

This  you  cannot  do  unless  you  have  a  business  system,  for 
upon  system  depends  both  your  professional  and  your  financial 
(280) 


HIS    REPUTATION    AND    SUCCESS.  281 

success.  No  man  is  at  his  best  when  handicapped  by  poverty ; 
and  no  one  can  practice  medicine  with  clearness  and  penetra- 
tion, earnestness  and  effect,  if  his  mind  be  depressed  and  dis- 
tracted, or  health  lowered  and  temper  vexed  by  the  debts  he 
owes,  or  be  annoyed  and  dunned  by  hungry  creditors  at  every 
corner ;  or  whose  discontented  stomach  is  uncertain  where  the 
next  meal,  for  himself  and  his  care-worn  family,  is  to  come 
from ;  or  who  walks  the  floor  and  knows  not  which  knock  at 
the  door  will  be  the  sherift''s.  These  and  other  cares,  that  pov- 
erty entails,  dwarf  any  (Deadbroke)  physician's  mind  and  body, 
and  cripple  his  work ;  and  it  is  only  when  free  from  the  incu- 
bus, the  mental  solicitude  of  debt  and  poverty,  that  his  mind 
and  his  energies  can  do  full  justice  to  his  attainments. 

"Anticipated  rents  and  bills  unpaid 
Force  many  a  doctor  into  the  shade." 

In  these  days  neither  untiring  study,  nor  unselfish  devo- 
tion as  a  humanitarian,  nor  the  bubble  of  applause  will  enable 
you  to  live  on  wind, — 

"All  leaf  and  no  fruit," — 

or  lift  you  above  the  demands  of  the  tailor,  the  instrument- 
maker,  the  book-seller,  the  grocer,  the  butcher,  and  other  cred- 
itors, not  one  of  whom  would  accept  your  reputation  for  pro- 
fessional devotion,  or  of  working  for  philanthropy,  or  your 
smiles,  thanks,  and  blessings  for  his  pay  ;  nay,  even  tlie  con- 
ductor will  repudiate  such  sentimental  notions,  and  put  you  off 
the  street-car  which  is  carrying  you  to  your  patient,  if  you  do 
not  have  money  to  pay  your  fare. 

"Wrinkled  jjurses  make  wrinkled  faces." 

It  is,  naturally,  a  pleasant  thing  to  be  very  popular ;  but  even 
were  your  air-built  popularity  and  verbal  fame  to  embrace  the 
whole  city,  neither  it  nor  checks  on  the  Bank  of  Fame  will  fill 
your  market-basket  nor  purchase  books,  pay  your  rent  nor  feed 
your  horse ;  and  although  the  Glittering  Dust  is  neither  the 
primary  nor  the  chief  incentive  in  the  practice  of  medicine,  it 


282  THE    PHYSICIAN    HIMSELF: 

ever  has  been  and  ever  must  be  one  of  the  objects,  for  no  one 
can  sustain  his  practice  without  a  money  feature. 

"Necessity  has  sharp  teeth." 

If  people  do  not  pay  you  you  cannot  live  by  your  calling,  and 
you  will  very  soon  tire  of  all  iDorh  and  no  pay.  Almost  as 
well  to  starve  without  a  patient. 

In  your  money  affairs  be  systematic  and  correct,  for  it  is  as 
important  to  charge  your  visits  as  it  is  to  make  them ;  malve  it 
your  habit  never  to  retire  to  bed  without  making  some  kind  of 
record  of  every  visit,  etc.,  made  during  the  day.  The  nearer 
your  financial  arrangements  approach  the  cash  system,  the 
better  it  will  be  for  you  and  your  family.  Frequent  accounts 
are  best  for  the  physician.  If  he  render  bills  promptly,  it 
teaches  people  to  look  for  them,  and  to  prepare  to  pay  them, 
just  as  promptly  as  they  do  other  family  expenses.  It  is  often 
more  advisable  even  to  submit  to  a  reduction  in  a  bill  for 
prompt  payment,  than  to  let  the  account  stand  over  and  run 
the  risk  of  losing  it  through  the  pay-when-you-please  system, 
for  while  you  are  waiting  some  may  fail  and  others  abscond. 
Besides,  after  settling  promptly,  many  patients  will  feel  free  to 
send  for  you  again  and  make  another  bill,  even  in  moderate 
sickness,  instead  of  dallying  witli  home  remedies  or  quack 
medicines,  as  they  might  do  if  they  still  owed  you. 

You  should  render  your  bills  while  they  are  small,  and 
your  services  are  still  vividly  remembered,  not  only  because 
gratitude  is  the  most  evanescent  of  human  emotion,  but  for 
another  reason :  if  you  are  neglectful  or  shamefaced  and  do  not 
send  your  bills  promptly,  it  will  create  a  belief  that  you  do  not 
believe  in  prompt  collecting,  or  are  not  dependent  •  upon  your 
practice  for  a  living,  or  have  no  wants  and  do  not  need  money ; 
or  that  you  do  not  hold  this  or  that  person  to  your  business 
rule,  or  are  not  uneasy  about  what  they  owe  you ;  and  if  you 
foster  a  bad  system  of  book-keeping  a  bad  system  of  collecting 
will  grow  up  around  you,  and  great  loss  will  result.  Asking 
for  payment  reminds  patients  that  there  is  still  a  little  of  the 


HIS    REPUTATION    AND    SUCCESS.  283 

human  left  in  a  man,  even  if  he  have  become  a  physician,  and 
that,  since  you  have  to  hve,  you  must  have  your  fees  to  enable 
you  to  do  so. 

The  business  of  the  world  is  now  conducted  on  the  cash 
system,  instead  of  the  old  Jong  credit  plan,  and  you  should  do 
your  share  to 

"Break  the  legs  of  the  evil  custom," — 

the  unjust  habit  that  physicians  used  to  follow,  either  through 
carelessness  or  to  maintain  the  favor  of  patients,  of  waiting  six 
months  or  a  year  after  rendering  services  before  sending  a  bill. 
If  a  physician  attend  a  person,  say  in  February,  and  send  his 
bill  in  March  or  April,  it  seems  to  the  patient  like  a  current  ex- 
pense, and  as  though  the  physician  lives  by  his  practice,  and  it 
is  apt  to  be  paid  promptly;  whereas,  if  he  delay  sending  it 
until  July  or  January,  and  then  send  one  headed  with  the  semi- 
apology,  "Bills  rendered  January  1st  and  July  1st,"  as  an  ex- 
cuse for  even  sending  it  then,  the  debtor  will  naturally  think  that 
the  physician  has  merely  sent  his  out  with  a  whole  batch  of  others, 
more  because  he  has  posted  his  books  than  from  a  special  de- 
sire for  its  payment ;  and  in  this  belief  he  will  probably  let  it 
remain  unpaid  for  months  longer,  and  perhaps  delay  its  settle- 
ment till  it  becomes  an  old  back  debt,  which  is  the  hardest  kind 
to  pay.  All  sorts  of  strange  accidents  are  continually  happen- 
ing that  may  prevent  payment ;  besides,  time  effaces  details, 
and  recollection  of  the  number  of  visits,  the  physician's  watch- 
ings,  cares,  and  anxieties  are  forgotten,  responsive  sensibility  is 
lost,  and  the  bill,  though  really  moderate,  is  apt  to  look  large. 
All  these  circumstances  combined  are  apt  to  make  people  feel, 
when  they  do  pay  an  old  bill,  not  as  though  they  are  paying  a 
well-earned  fee,  but  more  as  if  they  are  doing  a  generous  thing 
and  making  the  physician  a  present  of  that  amount. 

If,  in  spite  of  these  facts,  you  do  send  your  bills  only  every 
six  months,  instead  of  putting  on  them  "  Bills  rendered  every 
six  months,"  put  "  All  bills  collected  at  the  end  of  every  six 
months,"  or  "  Prompt  settlement  of  bills  is  kindly  requested." 


284  THE   PHYSICIAN    HIMSELF  I 

Also,  show  that  you  keep  records  of  your  cases  and  of  your 

fees  by  having  on  all  your  bills  the  word  Folio after  the 

patient's  name,  with  the  number  of  his  page  inserted  in  the  blank- 

You  will  have  to  make  considerable  reduction  in  many 
large  bills  after  they  have  become  old ;  therefore,  look  after  them 
while  they  are  small  in  amount  and  recent  in  date.  Indeed,  if 
you  let  one  bill  be  added  to  another  till  the  total  reaches  a  con- 
siderable amount,  you  may  place  it  wholly  beyond  the  power  of 
the  person  to  pay  it,  and  wrongfully  force  him  hito  the  position 
of  a  dishonest  man.  Besides,  long-standing  bills  frequently  lead 
to  a  disruption  of  friendly  feeling  and  loss  of  practice. 

"Old  reckonings  breed  new  disputes." 

The  very  best  time  to  talk  business,  and  have  an  under- 
standing about  fees  with  doubtful  or  strange  patients,  is  at  your 
first  visit  or  the  first  office  interview,  and  the  best  of  all  times 
to  judge  a  person's  true  character  will  be  not  on  occasions  for 
social  intercourse  and  the  ordinary  amenities  of  life,  but  when 
you  touch  his  financial  pocket-nerve  and  have  money  dealings 
with  him. 

"Then  you  will  find  out  what  stuff  they're  made  of." 

Even  a  single  dollar  will  sometimes  show  you  exactly  what  a 
person  is,  whether  a  knave  or  a  man  of  honor. 

Make  it  an  invariable  rule  never  to  accept  a  commission  or 
fee  from  any  one  under  circumstances  which  you  would  not 
wiUinghj  submit  to  public  exposure  or  investigation  by  a  medi- 
cal society,  or  a  court  of  justice.  Probably  your  severest  test 
will  be  when  money  is  enticingly  offered  to  induce  you  to  do 
doubtful  things. 

Many  and  many  a  patient  will  quit  employing  you  to  escape 
from  paying  an  old  bill,  and  then,  to  hide  from  their  surprised 
neighbors  the  true  cause  of  their  quitting  you,  will  trump  up 
some  falsehood  or  another,  and  give  you  a  bad  name,  to  prevent 
them  from  employing  you  and  thereby  possibly  learning  from 
your  lips  the  true  reason  why  they  changed. 


HIS    REPUTATION    AND    SUCCESS.  285 

Railroad  and  steam-boat  companies  and  other  corporations, 
also  proprietors  of  mills,  factories,  workshops,  etc.,  whose  em- 
ployes get  injured,  in  order  to  relieve  themselves  from  responsi- 
bility, or  from  fear  of  incurring  public  odium,  or  from  a  selfish 
fear  that  they  may  become  involved  in  suits  for  damages,  and  be 
made  pecuniarily  responsible  for  the  injury,  often  send,  directly 
or  indirectly,  for  a  physician  to  attend,  and  in  one  way  or  another 
create  an  impression  in  his  mind  that  they  will  pay  the  bill,  but 
afterward,  on  one  plea  or  another  (usually  this — that  they  have 
supported  the  injured  person  during  his  disability,  which  is  as 
much  as  they  can  aiford),  either  entirely  disclaim  the  debt  or 
refuse  to  pay  it,  and  with  such  excuses  leave  the  physician  in 
the  lurch. 

"Rank  injustice  that  smells  to  heaven." 

In  such  cases  you  may  obviate  this  result  and  secure  justice, 
or,  at  least,  ascertain  the  prospect,  by  going,  as  soon  as  possible 
after  you  have  taken  charge  and  given  the  initial  attention, 
directly  to  headquarters,  or  to  the  person  who  has  the  authority 
to  make  tlie  company  or  firm  financially  responsible  for  your 
services,  and,  after  explaining  the  labor  and  responsibility  which 
the  case  involves,  make  known  your  doubts  of  not  being  recom- 
pensed for  your  services  unless  they  will  see  to  it,  and  frankly 
ask  if  they  will  assume  the  responsibility  and  let  you  enter  the 
account  on  your  books  in  their  name. 

From  similar  motives,  the  heads  of  families,  for  their  own 
satisfaction,  for  social  reasons,  or  from  a  feeling  of  insecurity 
lest  some  inmate  of  their  house  who  has  become  sick  may  have 
a  contagious  disease,  will  sometimes  request  you  to  visit  their  ser- 
vants, nurses,  or  maybe  poor  relatives,  and  then  seek  to  avoid 
payment  of  your  bill  on  one  pretext  or  another.  If  there  be 
reasonable  doubt  of  prospective  payment  in  these  cases,  you 
had  better  at  once  seek  to  determine  the  financial  responsibility, 
as  suggested  in  the  preceding  paragraph. 

Bear  in  mind  the  fact  that  when  a  person,  even  though  a 
banker  or  a  millionaire,  comes  for  you,  or  summons  you,  or 


286  THE   PHYSICIAN    HIMSELF: 

requests  you  to  attend  another  person,  he  is  not  thereby  made 
legally  responsible  for  your  fees,  unless  he  distinctly  promises  or 
agrees  to  be  responsible  for  the  debt.  Hence,  make  it  a  rule 
to  enter  the  names  of  those  who  are  held  financially  responsible 
for  such  services  in  your  book,  and  keep  a  memorandum  of  tlie 
facts  that  make  them  so,  and  make  out  your  bill  to  them  accord- 
antly. If  you  take  these  precautions  it  will  prevent  many 
unpleasant  misunderstandings,  and  save  you  many  a  hard-earned 
dollar. 

Before  you  have  practiced  long  you  will  find  that  your  wel-« 
fare  will  depend  not  upon  how  much  you  book,  but  upon  how 
much  you  collect,  and  that  if  you  never  insist  upon  the  payment 
of  your  fees  you  can  never  separate  the  wheat  from  the  chaff. 
If  you  have  a  business  rule,  and  people  know  it,  they  will  asso- 
ciate you  and  your  rule  together,  and  be  guided  thereby.  Let 
the  public  know,  in  the  early  years  of  your  practice,  what  your 
rule  or  system  is,  or  you  cannot  do  so  later  in  life.  When  a 
new  family  employs  you,  render  your  bill  as  soon  after  the  ser- 
vices as  the  ordinary  courtesies  of  life  will  allow,  and  especially 
if  there  have  been  a  previous  attendant  who  was  a  careless  or 
indifferent  collector,  or  no  collector  at  aU.  Send  it  in  as  a  test, 
and  if  there  be  any  objection  to  you  consequent  on  the  early 
presentation  of  your  bill,  or  because  you  want  your  fee,  the 
sooner  you  arrive  at  an  understanding  of  each  other,  or  part 
company,  the  better  for  you. 

Some  physicians  have  more  tact  in  getting  fees  than  others, 
and,  curiously  enough,  there  are  patients  who  will  pay  one  phy- 
sician but  will  not  pay  another,  there  being  certain  persons  with 
whom  they  desire  to  stand  well,  and  others  for  whose  opinions 
they  do  not  care.  Try  to  be  in  the  former  class  with  all  persons 
of  doubtful  integrity. 

When  patients  ask  you  how  much  their  bills  are,  or  how 
much  they  are  indebted  for  office  consultations,  operations,  etc., 
always  reply,  with  courteous  promptness  and  decision,  "  one 
dollar,"  or  "  ten  dollars,"  or  whatever  else  the  amount  may  be, 


HIS    REPUTATION    AND    SUCCESS.  287 

large  or  small;  and  if  you  be  careful  to  avoid  prefacing  or  fol- 
lowing this  reply  with  other  words,  most  people  will,  in  the 
embarrassment  of  the  moment,  proceed  to  pay  you  without  ob- 
jection, whereas  if  you  add  more  words  it  will  weaken  your 
claim  in  their  minds,  or  impress  them  with  the  belief  that  you 
have  no  settled  charge,  and  will  furnish  them  with  a  pretext  to 
show  surprise  and  contend  for  a  reduction.  When  one  does 
demur  at  the  amount,  show  your  amazement,  and  be  prepared 
at  once  to  defend  or  explain  the  justice  of  the  charge. 

Your  accounts  for  surgical  cases,  midwifery,  poisoning 
cases,  and,  in  fact,  for  all  exceptional  cases,  should  be  promptly 
posted  and  charged  in  your  ledger;  otherwise,  the  patient 
may  call  unexpectedly  to  pay  his  bill,  and  you  may,  either 
through  haste,  or  embarrassment,  or  temporary  forgetfulness  of 
all  attendant  circumstances,  name  much  too  low  a  figure  and  do 
yourself  provoking  injustice.  Besides,  the  amount  being  already 
determined  on  and  entered  in  your  book  shows  it  to  be  the 
settled  charge,  and  the  patient  is  less  apt  to  ask  for  a  reduction. 

Take  your  fees  for  honest  services  whenever  tendered. 
Patients  will  often  ask,  "Doctor,  when  shall  I  pay  you] "  or 
"  Shall  I  pay  you  now  1 "  A  good  plan  is  to  answer  promptly, 
"Well,  T  take  money  whenever  I  can  get  it;  if  you  have  it, 
you  may  pay  it  now,  as  it  will  leave  no  bones  to  pick,"  or 
"  Short  payments  make  long  friends,"  or  "  Prompt  pay  is  double 
pay,  and  causes  the  physician  to  think  more  of  his  patient,"  or 
something  to  that  effect.  Never  give  such  answers  as  "Oh,  any 
time  will  do!"  or  "It  makes  no  difference  when,"  or  you  will 
soon  find  it  to  be  very  expensive  modesty. 

Although  Sunday  is  a  holy  day,  on  which  bills  should  not 
be  sent,  yet  it  is  perfectly  right  for  physicians  to  accept  fees 
earned  or  incidentally  tendered  on  that  day. 

Never  neglect  regularly  to  post  your  account-books,  for  it 
would  be  violating  nature's  first  law — which  says  that  the  first 
object  of  every  being  is  to  supply  his  own  wants — to  attend 
faithfully  to  the  department  of  your  occupation  that  concerns 


288  THE   PHYSICIAN    HIMSELF; 

others  and  neglect  the  one  that  concerns  yourself.  The 
Scripture  command  is,  "  Love  your  neiglibor  as  yourself;"  it 
does  not  say  love  him  more,  but  Paul  does  say  to  Timothy: 
If  any  one  provide  not  for  his  own,  and  specially  those  of  his 
own  house,  he  is  v^^orse  than  an  infidel. 

It  is  a  good  plan  to  insert  the  names  of  transient  patients 
in  your  cash-book,  instead  of  blurring  your  ledger  v^ith  them, 
and  to  give  pages  in  the  latter  only  to  probable  permanent 
patients. 

Try  to  get  cash  from  strangers  for  catheterization,  certifi- 
cates, vaccination,  and  other  minor  services,  instead  of  blurring 
your  ledger  with  petty  accounts. 

When  a  prompt-paying  patient  pays  cash  at  each  visit,  or 
settles  at  your  last  visit,  so  as  to  make  it  unnecessary  to  transfer 
his  account  from  your  visiting  list  to  your  ledger,  the  simplest 
way  to  mark  it  paid  is  to  turn  each  visit-mark  (/)  on  your  book 
into  a  P^  signifying  paid. 

A  good  plan  to  use  in  making  out  the  list  of  calls  you  are 
to  make  each  day,  and  the  order  in  which  you  wish  to  make 
them,  is  this:  Tear  up  a  lot  of  foolscap  or  note-paper  into  slips 
as  long  as  the  page  and  half  as  wide,  and  draw  a  line  down  the 
middle  of  one  side  of  each  ;  go  over  your  list  each  morning,  and 
cull  out  the  names  of  all  wlio  are  to  be  visited,  and  put  them 
on  one  of  these  strips,  left  side  of  the  line.  Then  select  and 
arrange  them  carefully  on  the  other  side  of  the  line  in  the  exact 
order  you  wish  to  observe  in  visiting  them,  putting  urgent  cases 
and  early  calls  at  the  top.  Cut  off  this  list  when  completed 
and  carry  it  in  your  outer  coat-  or  vest-  pocket,  refer  to  it  often, 
and  tear  off  each  name  as  the  visit  is  made. 

You  can  readily  fix  your  visiting-list  so  that  it  will  always 
open  at  the  page  in  use.  To  do  this,  clip  off  about  half  an  inch 
of  the  upper  corner  of  its  front  cover,  thus^,  and  then  in  like 
manner  cut  off  the  corners  of  the  leaves  thereby  exposed,  down 
to  the  page  corresponding  to  the  date  thereof.  When  thus 
prepared,  if,  in  opening  the  book,  you  place  your  right  thumb 


HIS   REPUTATION    AND    SUCCESS.  289 

on  the  exposed  corner  of  the  nncut  leaves,  it  must  open  at  the 
proper  page.  As  weeks  pass,  dip  each  page  as  required.  The 
most  convenient  way  to  carry  your  visiting-list  is  in  a  wide  but 
shallow  pocket  on  the  left  hip. 

Do  no  unnecessary  bookkeeping,  but  take  care  to  do  enougli 
to  keep  your  accounts  correctly.  The  visits  and  cash  entries  in 
your  visiting-list  and  day-book  should  be  written  in  ink ;  for, 
being  original  entries,  they  would  be  accepted  in  court  as  legal 
evidence.  A  good  way  to  prevent  any  one  or  any  thing  being- 
forgotten  is  to  write  names,  visits,  street  promises,  etc.,  in  your 
visiting-list  with  a  lead-pencil  without  delay,  till  you  have  a 
chance  to  rewrite  them  with  ink. 

Purple,  green,  and  blue  inks  all  fade  badly,  and  occasion 
a  great  deal  of  trouble.  You  liad  better  keep  your  books  with 
good  black  ink. 

At  the  end  of  every  week  add  up  the  visits  made  to  each 
patient  whom  you  have  attended  during  the  week,  and  after 
ascertaining  the  total  sum  which  you  should  charge  therefor, 
insert  that  amount  in  the  blank  spaces  found  at  the  end  of  the 
lines  after  the  Saturday  column  in  the  visiting-list.  By  doing 
this  weekly  you  can  fairly  estimate  and  charge  the  value  of 
your  services  to  each  patient  while  they  are  still  fresh  in  your 
mind.  It  is  not  only  wise  to  enter  at  the  end  of  each  week  the 
amounts  charged,  but  also  to  enter  the  names  of  tlie  individual 
members  of  the  family  who  have  been  under  your  care  during 
the  week,  in  the  visiting-list  over  the  visits,  for  reference^  in 
case  your  attendance  should  ever  be  disputed. 

In  posting  your  books  at  the  end  of  each  month,  in  order  to 
avoid  missing  any  entry  in  transferring  the  items  from  your  visit- 
ing-list to  the  ledger,  make  use  of  the  simple  checking-off  plan. 
A  good  way  is  to  make  a  list  of  the  names  of  all  patients  whom 
you  have  treated  during  the  month  on  a  sheet  of  foolscap  paper, 
then  bring  from  the  visiting-list  to  the  foolscap  the  amounts 
marked  against  them  for  each  week's  services  and  put  those  of 
each  after  his  name ;  when  you  have  all  the  charges  transferred 

19 


290  THE   PHYSICIAN    HIMSELF: 

in  this  way  to  the  foolscap,  begin  and  go  over  your  ledger,  page 
after  page,  and  scan  every  account  as  you  go  along.  When 
you  reach  the  name  of  any  one  against  whom  you  have  a  charge 
to  make,  add  up  all  you  have  marked  on  the  foolscap  against 
him,  and  enter  the  total  on  his  page  of  the  ledger ;  but  instead 
of  wasting  time  to  write  November,  1892,  $7.00,  enter  11-92, 
$7.00,  then  cross  that  person's  name  off  the  foolscap  list,  and 
continue  on,  page  after  page,  through  the  entire  ledger.  By 
this  crossing-off  system,  if  you  chance  to  pass  over  any  one's 
account,  it  will  remain  uncrossed  when  you  are  through  the  list, 
and  will  thus  be  detected.  While  going  over  the  different  pages 
of  the  ledger  note  down  on  the  blank  after  the  word  folio,  on 
one  of  the  small  pile  of  blank  bills  lying  at  hand  for  the  pur- 
pose, the  number  of  each  one's  page  whose  account  needs 
RENDERING,  so  that  on  completing  your  entries  you  may 
readily  return  and  make  out  the  bills  in  question ;  also,  take 
care  while  turning  the  pages  to  make  a  list  of  the  indebted 
patients  whose  accounts  it  would  be  well  for  you  or  your 
collector  to  look  after  during  the  ensuing  month. 

When  you  make  out  a  bill,  enter  in  your  ledger,  in  the 
space  just  after  the  amount,  the  date  on  which  the  bill  for  that 
amount  was  rendered ;  thus,  $7.00,  with  1-8-92  after  it,  would 
signify  that  a  bill  for  seven  dollars  was  rendered  to  that  person 
on  the  first  day  of  the  eighth  month,  1892;  or  it  may  be  written 
as  the  Quakers  do,  month  first,  then  day,  and  then  year,  thus: 
8-1-92.     Payments  may  be  similarly  entered. 

A  good  way  to  save  the  trouble  of  looking  over  worthless 
or  lapsed  accounts  in  your  ledger,  month  after  month  and  year 
after  year,  is  to  cross  them  off,  using  lead-pencil,  which  can  be 
erased  at  any  time,  if  necessary,  for  sucli  as  may  possibly  be 
revived ;  and  for  those  that  are  dead  or,  from  other  causes, 
never  likely  to  employ  you  again,  use  ink. 

That  a  patient  whose  name  is  on  your  books  is  a  colored 
person  can  easily  be  indicated  by  putting  three  dots  after  his 
name,  thus:    Robinson,  John,  •   13  Columbia  Street. 


HIS    REPUTATION    AND    SUCCESS.  291 

Patients  will  occasionally  dispute  the  correctness  or  just- 
ness of  your  charges.  If  a  bill  be  not  correct,  correct  it  at  once 
and  willingly,  with  such  an  expression  of  regret  at  the  error  as 
may  be  judicious ;  if,  however,  it  be  correct  and  just,  do  not 
allow  yourself  to  be  browbeaten  into  the  position  that  it  is  other- 
wise. Many  people  are  not  aware  that  the  charges  for  surgiccC 
and  various  other  cases  are  higher  than  for  ordinary  visits ;  some 
appear  to  think  that  for  a  visit  at  which  you  reduce  a  disloca- 
tion, open  a  large  abscess,  make  a  vaginal  examination,  or  draw 
off  the  urine,  you  should  charge  the  same  as  for  ordinary  visits ; 
others  have  an  idea  that  physicians  do  not,  or  should  not,  charge 
for  every  visit  when  they  make  more  than  one  visit  in  a  day,  or 
for  every  patient  when  more  than  one  in  a  house  is  sick.  You 
must,  of  course,  correct  their  error  by  explaining  the  relative 
difference,  or,  if  necessary,  by  reference  to  the  fee-table. 

Never  undercharge  for  your  services  with  a  view  of  obtain- 
ing business,  or  in  any  other  odious  sense.  A  community  never 
values  a  physician  higher  than  he  values  himself;  besides,  ha- 
bitual deviation  from  the  uniform  rate  of  charging  is  considered 
dishonorable  and  is  ruinous  to  one's  interests  and  to  the  inter- 
ests of  the  profession  at  large.  Moreover,  the  public  knows  that 
no  man  will  be  content  with  small  and  insufficient  fees  while 
his  brethren  are  receiving  greater,  unless  he  rates  his  abilities  at 
a  less  price.  Small  fees  are,  therefore,  set  off  against  small 
skill  in  the  public  belief.  The  tendency  of  undercharging  is 
to  put  a  lower  value  on  the  medical  profession,  to  lower  the  fee- 
table  permanently,  and  to  compel  all  physicians  to  work  for 
inadequate  pay.  There  is  a  vast  difference  between  underbid- 
ding in  our  profession  and  that  seen  in  wars  of  competition  in 
ordinary  business  pursuits.  In  the  latter,  underselling,  cut-rates, 
and  other  results  of  severe  and  crushing  competition  are  onlv 
temporary ;  for,  if  merchants  or  traders  were  to  sell  goods  at  or 
below  cost  for  a  length  of  time,  failure  would  result.  In  com- 
mercial or  business  wars  one  or  other  withdraws,  or  they  enter 
into  a  compromise  and  each  advances  again  to  full  prices  ;  snap- 


292  THE    PHYSICIAN    HIMSELF  '. 

ping  and  snarling  physicians,  on  the  contrary,  having  no  goods 
to  manufacture  or  sell,  one  determined  to  triumph  and  the  other 
resolved  to  prevail  over  his  "  opponent "  (!)  by  underbidding 
and  exposing  each  other's  misfortunes,  may  keep  up  the  strain 
of  rivalry  and  efforts  to  crush  or  banish  each  other  for  years, 
dispensing  their  skill  to  everybody  for  insignificant  or  nominal 
fees,  impoverishing  one  another,  and  almost  starving  those 
depending  on  them  for  support. 

"Wars  bring  scars." 

Besides, 

"What  can  war,  but  endless  war  still  breed?" 

Surely  we  suffer  enough  annoyance  in  the  proper  pursuit 
of  our  profession,  without  adding  to  our  troubles  by  such 
struggles. 

Unless  you  already  have  a  regular  scale  of  charges  in  your 
I'egion,  try  to  bring  about  a  somewhat  uniform  fee-table  or  rate 
of  charging  among  the  body  of  physicians. 

The  wisest  rule  in  charging  for  your  services  is  to  do  your 
work  well,  then  ask,  even  from  the  beginning  of  your  career, 
the  fees  usual  for  conscientious,  skilled  attendance,^ — neither 
exorbitantly  high,  like  an  extortioner,  nor  absurdly  low.  And 
always  maintain  that  your  services  are  as  good  as  the  best. 

Let  people  know  that  you  honestly  strive  to  make  your 
bills  as  small  as  possible,  not  by  undercharging,  but  by  getting 
them  well  by  good  treatment  and  with  as  few  visits  as  possible. 

Never  enter  into  an  auction  bargain  to  attend  a  patient  or 
a  family  by  the  week,  month,  or  year ;  it  is  far  better  to  be 
paid  for  what  you  actually  do,  than  to  have  some  people  feel 
that  they  are  giving  you  twenty  dollars  for  five  dollars'  worth 
of  service,  while  you,  on  the  other  hand,  are,  in  many  other 
exacting  cases,  giving  fifty  or  a  hundred  dollars'  worth  of  ser- 
vice for  twenty  dollars,  and  have  no  alternative  but  to  fulfill 
the  contract. 

Also,  never  bargain  to  attend  whole  neighborhoods  or  clubs 
of  poor  people  at  reduced  rates,  or  at  half-  or  quarter-  price, 


HIS   REPUTATION    AND    SUCCESS.  293 

because  your  antiquated  or  unripe  neighbor  does ;  it  is  bad 
policy,  and  never  works  successfully.  Indeed,  if  you  ever 
attend  a  confinement  or  other  case  in  a  family  for  a  nominal 
fee,  or  lump  your  bill  for  ready  money,  they  will  always  expect 
to  pay  what  they  paid  before,  and  you  will  not  be  able  to  raise 
your  scale  of  charges  to  the  regular  price  in  that  family  after 
your  standing  and  skill  improve  and  your  time  becomes  more 
valuable  ;  or  even  with  other  patients  who  hear  of  it. 

It  is  a  mistake  to  think  that  you  can  greatly  augment  the 
charges  you  make  in  the  beginning  of  your  practice  as  you 
advance  in  age,  skill,  and  experience,  as  everybody  will  appeal 
to  your  former  charges,  and  object.  After  becoming  accustomed 
to  small  prices,  old  patients  will  even  think  you  ought  to  charge 
them  less  instead  of  more ;  so  that,  if  ever  you  feel  unwilling  to 
repeat  services  of  any  kind  for  the  sum  received  for  a  previous 
case,  be  careful  to  give  the  patient  fair  notice  of  your  intention 
to  raise  your  charges. 

One  of  the  hardships  of  our  profession  is  that  the  older 
men,  perhaps  now  rich,  or  deriving  their  support  chiefly  from 
their  stocks,  bonds,  four-per-cents,  or  farms,  continue  to  charge 
the  low  prices  of  half  a  century  ago,  while  the  price  of  living, 
etc.,  have  all  advanced;  so  that  the  younger  physician,  without 
these,  must  charge  somewhat  the  same,  and  thus  hardly  get 
revenue  enough  to  support  him. 

A  wise  man  usually  accommodates  himself  to  circumstances 
and  takes  what  he  can  get,  but  even  when  you  are  sure  that,  to 
meet  one's  means  of  remuneration,  you  will  have  to  receipt 
your  bill  for  a  reduced  amount,  make  it  out  for  the  standard 
amoimt,  so  that  the  debtor  may  see  the  real  extent  of  his  in- 
debtedness and  give  you  credit  for  the  amount  of  the  reduction ; 
in  other  words,  when  you  make  a  reduction  to  those  who  plead 
poverty  or  other  acceptable  reason,  let  them  understand  that 
you  are  not  reducing  your  charges,  but  are  taking  something  off 
their  bill ;  and  enjoin  upon  them  not  to  tell  it  around,  lest  it 
lower  your  scale  of  charges  elsewhere. 


29i  THE    PHYSICIAN    HIMSELF: 

In  attending  an  extraordinary  case  for  Mr.  Bullion,  or  Gov. 
Goldmine,  or  Gen.  Doublebank,  or  Maj.  Opulent,  or  Capt. 
Creamyrich,  Mrs.  Bountiful,  or  any  one  else  who  is  very  rich 
or  notoriously  liberal,  after  properly  calling  his  attention  to  the 
immeasurable  value  of  the  life  you  have  saved,  or  of  the  bless- 
ing and  health  your  services  have  given,  leave  to  him  the  money 
valuation  of  the  benefits  the  restoration  brings,  or  the  worth  of 
exemption  from  death,  unless  he  insist  on  having  a  bill.  In 
the  latter  case,  charge  him  no  more  than  any  one  else  for  the 
same  services.  In  tlie  former  you  may,  by  submitting  it  to  him, 
from  his  feeling  of  superlative  delight  at  the  successful  issue,  be 
paid  most  munificently,  possibly  ten  times  as  much  as  your  bill 
would  have  been. 

When  people  talk  to  you  about  taking  off  part  of  their  bill 
because  they  are  poor,  and  charging  the  rich  more  to  make  it 
up,  take  less  if  you  think  proper,  but  under  no  circumstances 
allow  tliem  to  infer  that  you,  or  any  other  physician,  would 
charge  any  one,  whether  rich  or  poor,  a  cent  more  than  is 
honestly  your  due. 

It  is  customary  and  just  to  charge  a  double  fee  for  the  first 
or  for  an  only  visit  in  a  case,  chiefly  for  the  following  reasons : 
You  must  at  the  first  visit  devote  an  extra  amount  of  time  and 
attention  to  learning  the  history  of  the  case, — maybe  make  a 
minute  time-consuming  examination, — must  involve  yourself  in 
a  diagnosis,  and  probably  also  in  a  prognosis, — must  carefully 
think  over  and  decide  upon  a  whole  line  of  treatment, — must 
instruct  the  nurses, — map  out  the  quality  and  quantity  of  diet, 
drink,  exercise,  etc., — point  out  the  requirements  of  hygiene, 
maybe  institute  asepsis  or  antisepsis, — lay  down  general  rules 
regarding  lighting,  heating,  and  ventilation,  the  clotliing,  the 
temperature,  the  toilet,  idiosyncrasies,  etc.,  and  formally  establish 
yourself  in  the  case,  and  assume  all  the  responsibilities  of  the 
issue.  These  combined  make  it  an  extraordinary  visit,  and  fully 
justify  a  double  charge  for  the  first  visit. 

The  first  visit  to  a  case  may  be  easily  designated  by  turning 
the  visit-mark  (/)  into  an  F. 


HIS    REPUTATION    AND    SUCCESS.  295 

It  is  also  just  to  charge  extra  for  a  visit  in  which  you  are 
detained  longer  tlian  (say)  a  half-hour,  or  in  an  obstetrical  case 
over  five  or  six  hours,  either  by  the  urgency  of  the  case  or 
where  the  family  request  you  to  remain. 

There  are  a  few  people  who  consider  that  when  a  case  is 
serious  enough  to  require  the  physician  to  make  more  than  one 
visit  a  day  he  should  not  charge  for  the  additional  visits,  uncon- 
scious, as  it  were,  of  the  fact  that  cases  dangerous  enough  to 
require  an  extra  number  of  visits  are  the  very  ones  which  entail 
upon  him  the  greatest  responsibility,  cause  him  most  anxiety, 
and  contribute  most  largely  toward  making  liis  life  one  of 
wearying  labor  and  self-denial. 

When  you  attend  two  or  more  patients  in  a  family  at  the 
same  time,  take  care  to  charge  full  rates  for  one  patient  and 
half-rates  for  each  of  the  others. 

You  will  often  have  people  to  hum  and  haw,  and  complain 
that  their  bill  is  high,  and  ask  you  to  make  a  reduction ;  yet, 
many  of  these  very  people  would  not  employ  you  if  you  were 
a  third-rate  or  low-priced  physician.  Everybody  wants  first- 
class  services,  but  wants  them  as  cheaply  as  possible.  It  is  not 
human  nature  to  prefer  a  fifty-cent  to  a  two-dollar  silk :  but 
if  people  be  lucky  enough  to  get  the  two-dollar  silk  for  one 
dollar,  they  congratulate  themselves.  They  reason  the  same 
about  physicians ;  very  few  prefer  or  appreciate  a  low-priced 
(cheap-John)  physician. 

In  unusually  severe  cases,  and  in  those  which  require 
very  great  exposure  or  extraordinary  legal  or  professional 
responsibility :  in  cases  of  recovery  after  poisoning,  or  of  appar- 
ent drowning,  or  suft'ocation,  of  small-pox  and  other  loathsome 
and  contagious  diseases,  the  fear  of  which  prevents  other 
patients,  who  know  you  are  attending  them,  from  employing 
you,  or  which  necessitate  loss  of  time  in  changing  your  clothes 
and  otherwise  disinfecting  yourself  before  visiting  others  who 
are  not  affected,  or  in  which  you  have  evinced  remarkable  skill, 
or  where  you  have  had  very  great  luck  in  bad  cases  of  any  kind, 
you  should  charge  good,  round  fees. 


296  THE    PHYSICIAN    HIMSELF: 

It  is  certainly  worth  far  more  successfully  to  attend  an 
important  or  distinguished  member  of  the  community  in  a  case 
of  pneumonia — in  which  you  save  his  life  as  clearly  as  if  you 
had  dragged  him  helpless  from  the  flames,  or  plucked  him 
drowning  from  the  water ;  or  a  patient  with  apoplexy,  or  with 
a  wound,  ulcer,  fracture,  or  a  luxation,  or  a  contagious  disease 
in  which  you  risk  losing  your  own  life ;  in  fact,  anything  that 
causes  you  great  anxiety  and  necessitates  much  study — than  one 
for  whom  nobody  cares,  with  a  sore  finger  or  toe,  or  chicken- 
pox,  mumps,  or  hives,  even  though  the  two  cases  require  an 
equal  amount  of  time,  or  a  like  number  of  visits. 

In  some  cases  your  charge  will  be  not  so  much  for  the 
work  actually  performed  as  for  your  knowledge  and  skill  in 
knowing  how  to  do  it;  for  instance,  you  may  charge  twenty 
dollars  for  the  few  minutes'  work  of  reducing  a  luxated  hume- 
rus ;  if  this  were  duly  itemized  it  might  read  thus  :  "  For  re- 
ducing dislocated  shoulder,  five  dollars ;  for  expense  and  study 
of  learning  how  to  do  it,  fifteen  dollars."  "  You  charge  me 
fifty  sequins,"  said  a  Venetian  nobleman  to  a  sculptor,  "  for  a 
bust  that  cost  you  only  ten  days'  labor."  "  You  forget,"  replied 
the  artist,  "  I  have  been  thirty  years  learning  how  to  make  that 
bust  in  ten  days. 

Attendance  on  Bigbee's  beloved  child,  on  an  eminent  or 
very  important  member  of  the  community,  or  on  one  of  the 
great  men  of  the  land,  for  whose  life  you  have  fought  a  great 
battle,  or  on  a  well-satisfied  stranger  who  has  journeyed  far 
with  an  important  case  that  causes  you  special  solicitude  and 
anxiety,  or  on  a  case  that  presents  peculiar  difiiculties,  justifies 
you  in  making  a  special  charge,  whether  attended  at  your  own 
office  or  at  the  homes  of  the  patients.  In  such  cases  pay  every 
necessary  attention,  but  be  careful  to  make  no  unnecessary 
visits,  unless  by  special  request ;  for  in  a  very  important  case, 
in  which  three  visits  would  be  really  necessary,  to  which  you 
make  but  three  and  then  discharge  yourself,  your  services  will 
be  appreciated  more  highly,  and  the  family  will  more  cheer- 


HIS    REPUTATION    AND    SUCCESS.  297 

fully  pay  a  fee  of  a  hundred  dollars  than  if  you  had  also  made 
five  additional,  apparently  unnecessary,  visits,  and  charged  but 
eighty  dollars. 

On  the  same  principle,  when  you  have  severe  cases  of  any 
kind  that  necessitate  several  visits  in  the  course  of  the  day,  take 
care  to  diminish  the  number  markedly  as  soon  as  the  necessity 
ceases. 

In  extraordinary  and  complex  cases ;  also,  where  the  re- 
sults are  apt  to  be  great  and  far-reaching,  or  in  which  you  go  a 
long  distance,  or  at  very  unusual  hours,  or  through  great  storms, 
or  extra  dangers,  the  charge  should  be  not  by  the  visit,  but  for 
the  case. 

Patients  will  often  express  surprise  at  your  asking  the  same 
fee  for  office  advice  as  for  a  visit  to  their  house  ;  explain  to  them 
that,  although  the  charge  is  the  same,  it  is  much  cheaper  to  be 
an  office  patient  than  to  be  visited  at  home,  because  an  office 
patient  usually  comes  but  once,  or  oiiJi/  when  his  medicines  are 
out,  or  when  some  important  change  has  taken  place  in  his 
ailment,  and  quits  entirely  as  soon  as  possible ;  whereas,  if  you 
have  him  under  care  at  home,  your  responsibility  and  feeling  of 
uncertainty  compel  you  to  visit  him  frequently  to  ascertain 
whether  he  is  getting  along  as  expected.  For  these  reasons  a 
few  office  consultations  with  the  responsibility  of  attending 
faithfully  resting  on  the  patient,  if  on  either,  often  suffice,  in- 
stead of  many  house  visits,  and  in  this  way  office  advice  becomes 
very  much  cheaper. 

Some  people  who  are  mean  and  miser-like  about  paying 
— as  big  and  exacting  as  tyrants  when  sick,  and  as  small  as 
potato-bugs  at  bill  time — will  want  you  to  deduct  largely  from 
their  bills,  especially  if  they  happen  to  be  mostly  for  office  con- 
sultations, vaccinations,  and  other  services  of  a  less  important 
character.  Meet  them  at  once  with  the  argument  that  if  they 
are  to  pay  you  less  than  the  average  for  the  minor  services,  you 
will  have  to  charge  them  on  a  much  higher  scale  of  fees  for  the 
more  important  ones.     But  with  such  people  the  question  is  not 


298  THE    PHYSICIAN    HIMSELF: 

services,  but  money,  and  you  will  often  have  a  stinted  sum 
grudgingly  given,  even  for  the  saving  of  life. 

Be  kind  to  the  poor  and  lenient  with  the  unfortunate,  but 
when  people  are  able  you  should  be  as  rigid  in  requiring  your 
pay  as  other  men. 

The  difference  between  words  used  with  your  office  patients 
will  sometimes  make  all  the  difference  between  a  fee  and  no  fee. 
Some  who  consult  you,  if  asked  to  call  again  to  let  you  know 
Jioio  they  are  getting  on,  will,  on  returning,  show  by  every  word 
and  action  that  they  do  not  expect  to  pay,  as  they  merely  called 
because  you  requested  them  to  do  so.  Therefore,  unless  you 
intend  to  omit  the  charge,  it  is  better  to  advise  them,  to  consult 
you  again,  at  such  time  as  you  deem  proper  to  specify.  This  will 
distinctly  intimate  to  them  that  your  usual  fee  will  be  charged. 

When  a  new  patient,  whose  honesty  you  have  reason  to 
doubt,  consults  you  at  your  office,  and  instead  of  paying  the  fee 
defers  it,  with  a  promise  to  call  again,  if  you  request-  his  name 
and  residence,  and  book  them  in  his  presence,  your  chances  of 
getting  paid  will  be  greatly  increased. 

Never  agree  or  enter  into  a  contract  to  attend  any  one  for  a 
"contingent  fee" ;  that  is,  do  not  take  patients  with  chronic  sores, 
constitutional  headaches,  epilepsy,  cancer,  post-nasal  catarrh, 
pimpled  faces,  haemorrhoids,  dyspepsia,  hypochondriasis,  and 
other  chronic  affections ;  or  victims  of  syphilis,  gonorrhoea,  the 
ruthless  blight  of  scrofula,  etc.,  on  the  "?^o  cure,  710  2)(iy"  system, 
or  to  pay  ''if  their  rainhoio  expectations  are  realized,^^  or  '"'when 
all  is  over^  Enter  into  no  such  one-sided  agreements  to  do 
things  that  may  prove  impossible,  for  they  are  never  satisfactory, 
and  will  generally  end  in  your  being  swindled,  and,  it  may  be, 
charged  with  incompetence  or  malpractice.  In  expressing  your 
willingness  to  undertake  such  case,  let  it  be  clearly  understood 
that  if  the  case  be  curable,  then  you  are  there  to  cure  it,  but  that 
you  charge  for  services,  not  for  residts,  and  must  be  paid  for 
your  attendance  even  though  the  patient  proves  incurable  or 
dies,  and  that  all  who  seek  your  advice  must  take  the  proba- 


HIS    REPUTATION    AND    SUCCESS.  299 

bilities  of  cure  or  relief  from  your  well-intended  endeavors. 
Hemember :  having  accepted  charge  of  a  case,  you  are  morally 
bound,  pay  or  no  pay,  conscientiously  to  fulfill  your  duty  to  the 
patient;  you  may,  nevertheless,  fairly  intimate  to  those  who 
you  think  are  unworthy  of  credit,  that  if  they  pay  as  they  go 
on,  instead  of  running  up  a  bill,  it  will  tend  to  encourage  and 
interest  you  more  in  the  case,  and  naturally  inspire  and  stimu- 
late you  to  do  your  best. 

Some  persons  suffering  from  constitutional  syphilis,  ulcer- 
ated legs,  chronic  eczema,  broken  constitution,  etc.,  in  which  the 
treatment  may  extend  through  many  months,  or  maybe  for 
years,  or  even  through  life-time,  will  probably  suggest  that  you 
should  wait  for  your  fees  till  done  attending.  Do  no  such  fool- 
ish thing,  as  such  a  case  may  die,  or  move  away,  or  abandon 
treatment,  or  slip  away  from  you  to  another,  or  begin  with, 
jjrandmother  remedies,  or  with  "  varbs  from  those  who  have  no 
larnin',''  or  even  resist  all  your  attempts  to  effect  a  cure,  and 
you  may  get  nothing  except  misrepresentation  for  all  your 
work. 

In  such  cases,  it  is  far  more  just  and  wise  to  render  your 
accounts  at  the  proper  time, — "  for  the  three  months  ending 

,"  or,  at  the  very  furthest,  the  first  day  of  every  July  and 

January.  If  they  demur  (which  they  cannot  justly  do)  do  not 
hesitate  to  express  your  surprise  at  their  doing  so,  and,  in  re- 
minding them  of  the  necessity  for  living  by  your  practice, 
cautiously  but  firmly  tell  them  of  your  entire  unwillingness  or 
financial  inability  to  allow  your  fees  to  accumulate  as  they 
suggest. 

You  should  ordinarily  exact  no  previous  stipulation  of  pay, 
and  manifest  no  undue  anxiety  in  respect  to  your  fees,  and  make' 
no  reference  to  your  intended  charges,  unless  you  are  dealing 
with  people  notoriously  unworthy  of  confidence,  or  when  a  mis- 
understanding is  apprehended ;  but  in  most  instances,  unless 
the  patient  be  well  known  to  you,  you  should  not  hesitate  to 
require  your  fee  in  advance  (your  chance  of  compensation  will 


300  THE   PHYSICIAN    HIMSELF: 

grow  worse  as  the  patient  grows  better)  for  attending  cases 
of  secret  diseases.  If  you  fail  to  do  so,  Mr,  Hightone  or  Mr. 
Lowtone,  or  Mr.  Notoneatall,  as  the  case  may  be,  will  almost 
certainly  leave  you,  about  the  time  that  Richard's  himself  again, 
with  his  bill  unpaid ;  and  if  you  press  him  about  it,  he  will 
either  pay  it  grudgingly  or  not  at  all ;  and,  should  you  dun  him 
for  it,  will  abuse  you,  and,  with  vinegar  or  ice  in  his  looks, 
meanly  assert  that  he  is  absolutely  a  Joseph,  and  that  it  was 
not  an  ignoble  disease  at  all,  but  only  a  strain,  or  that  you  did 
him  no  good,  or  almost  killed  him ;  or  tell  some  other  falsehood 
as  an  excuse  for  deserting  and  trying  to  defraud  you,  and  ever 
after  try  to  bring  you  into  public  odium  and  to  injure  you  to 
the  extent  of  his  influence.  In  such  case  it  would  serve  him 
right  to  "  Court "  him.  Another  reason  why  it  is  proper  to  get 
your  fee  in  advance  is  that  many  would  never  come  and  pay  it 
till  you  had  sent  them  a  bill  by  your  collector,  and  would  then 
indignantly  claim  that  you  had  insulted  and  exposed  them  by 
sending  a  bill  of  that  kind. 

Also,  when  at  all  convenient,  get  your  fees  in  advance  for 
transient  attendance  on  persons  injured  in  bawdy-house  fights, 
drunken  buggy-rides,  soldiers,  sailors,  and  the  like. 

At  the  same  time,  bear  in  mind  that  you  have  no  right, 
either  legal  or  moral,  to  expose  the  nature  of  any  person's  dis- 
ease to  any  one,  on  account  of  his  having  failed  to  pay  your 
fees,  even  though  it  was  gonorrhoea  or  he  was  covered  from  the 
crown  of  his  head  to  the  soles  of  his  feet  with  syphilis. 

Venereal  diseases  are  the  result,  generally,  not  of  providen- 
tial misfortune,  as  are  other  inflictions,  but  of  voluntary  indul- 
gence in  vice ;  therefore,  self-inflicted.  And  for  this  valid  reason 
such  venereal  patients  have  not  the  same  natural  claim  upon 
your  sympathy  as  other  sufferers.  In  all  cases  of  this  kind  try 
to  get  a  just,  remunerative  fee  before  you  undertake  the  treat- 
ment ;  then  honestly  do  your  duty  to  the  patient  until  he  is 
cured.  Having  paid  you,  he  is  not  likely  to  change  from  you 
to  another,  and  should  his  case  proceed  slowly  he  cannot  then. 


HIS   REPUTATION    AND    SUCCESS.  301 

suspect  that  you  are  purposely  running  a  heavy  bill  on  him,  or 
delaying  the  cure  on  account  of  his  being  a  good-pay  patient, 
as  he  might  do  if  he  were  paying  you  a  dollar  or  two  for  each 
consultation. 

Many  men  imagine  that  they  cannot  be  suffering  from  con- 
stitutional syphilis  unless  they  have  detected  a  terrible  chancre 
at  the  beginning ;  and  you  will  often  experience  a  difficulty  in 
making  persons  who  have  not  detected  a  primary  sore  believe 
their  case  to  be  syphilis.  Some  men  will  actually  stare,  scan, 
and  quiz  you  when  you  tell  them  they  have  the  p-x,  as  if  they 
thought  you  a  quack  or  impostor  trying  to  frighten  them  out 
of  money.  If  you  can  show  such  a  patient  a  fac-simile  of  his 
chancre,  roseola,  or  mucous  patches  in  your  text-books  on  vene- 
real diseases,  or  even  read  with  him  a  description  of  them,  it 
will  awaken  him  to  his  real  condition  and  put  him  on  his  guard 
against  either  neglecting  his  case  or  infecting  others. 

When  you  feel  certain  that  your  diagnosis  of  syphilis  is 
correct,  look  the  patient  in  the  face,  and,  with  a  manner  that 
indicates  your  practical  knowledge  of  the  matter,  tell  him  that 
in  your  opinion  he  has  true  syphilis,  and  be  careful  not  to  be 
browbeaten  into  taking  charge  of  the  case  for  a  trifling  fee. 
It  is  a  grave  disease,  and  the  responsibility  and  worry  of  the 
medical  attendant  are  often  very  great  and  protracted ;  the  fee, 
therefore,  should  never  be  nominal. 

You  can  readily  broach  the  fee  question  to  any  patient  suf- 
fering from  a  private  disease  by  remarking,  immediately  after 
making  your  first  examination,  "  Well,  I  see  what  your  case  is, 
and  am  willing  to  take  charge  of  it  and  give  you  my  best  ser- 
vices, if  my  terms  will  suit  you.''''  This  will  necessitate  his 
asking  what  your  terms  are,  and  will  afford  you  the  oppor- 
tunity to  tell  him.  Or,  if  you  regard  the  services  likely  to  be 
required  as  important  and  valuable,  whilst  he  evidently  thinks 
the  reverse,  if  you  will  incidentally  begin  with  the  remark, 
*'Ah !  I  fear  my  charges  will  be  more  than  you  would  be  will- 
ing to  pay,"  this  also  will  compel  him  to  question  you  upon  the 


302  THE   PHYSICIAN    HIMSELF  I 

subject,  and  that,  too,  in  a  somewhat  more  favorable  frame  of 
mind  for  your  purpose. 

Some  people  labor  under  the  impression  that  physicians  are 
public  functionaries,  and  that  tlie  law  compels  them  to  answer 
the  beck  and  call  of  any  one  who  chooses  to  send  for  them,  pay 
or  no  pay.  It  does  not ;  you  have  a  perfect  right  to  refuse  for 
any  reason  that  is  satisfactory  to  yourself;  but  your  time  is  sup- 
posed to  belong  somewhat  to  your  suffering  fellow-creatures,  and 
you  are  expected  to  be  ever  waiting  and  watching  in  complete 
readiness ;  and  both  the  profession  and  public  opinion  would 
severely  judge  and  condemn  you  if  you  were  to  refuse  to  attend 
an  urgent  case  to  which  common  humanity  should  prompt  you 
to  go, — especially  if  you  refused  on  account  of  fees,  and  particu- 
larly if  other  physicians  were  not  easily  accessible.  If  you  are 
really  "  too  busy"  or  "  not  well  enough^"  or  are  immersed  in 
another  engagement  that  cannot  be  set  aside,  or  have  another 
equally  urgent  duty  to  perform,  these  will  generally  be  regarded 
as  sufficient  reasons,  and  protect  you  against  argument  or  criti- 
cism. But  "/'??7  just  at  dinner^"  '■'"Fm  too  tired,"  or  "/  need 
sleep,''^  or  "/  am  afraid  I  luill  be  dragged  hito  court  as  a 
icltness"  etc.,  look  like  a  hard  indifference,  and  are  not  accepted 
by  the  public  as  adequate  reasons  for  refusing  to  go,  and  in  cases 
of  urgency  should  never  be  offered.  In  the  name  of  Jupiter, 
what  business  has  any  physician  to  be  at  dinner,  or  sleepy,  or 
tired,  while  yet  young  enough  to  crawl,  or  with  strength  enough 
left  to  think  a  thought,  or  hold  a  pen,  when  the  sick  public  give 
a  call  or  whistle  1 

A  few  persons  also  believe  there  is  some  law  or  rule  that 
prevents  a  physician  from  attending  his  own  wife  and  children, 
or  other  near  kinsmen,  when  they  are  sick.  This  belief  has 
been  created  by  the  fact  that  some  esteemed  brother-physician 
is  generally  intrusted  with  such  cases  through  a  fear,  in  the 
physician's  anxious  mind,  that  personal  interest  in  those  so  near 
and  dear  to  him  might  warp  his  judgment,  or  in  the  event  of 
fatal  issue  might  leave  a  deep  and  lasting  regret  in  his  mind 


HIS    REPUTATION   AND    SUCCESS.  303 

that  this,  that,  or  the  other  Une  of  treatment  was  not  pursued 
instead  of  that  which  was. 

After  your  work  in  many  a  case  is  done  you  may  have  to 

"Assume  tlie  cloak  of  necessity  to  save  the  fee," 

and  use  this,  that,  or  the  other  stratagem  to  get  your  fees.  Not 
only  should  you  send  your  bill  to  a  patient  in  due  time,  but  if 
you  fail  to  hear  from  him  within  a  reasonable  while,  emphasize 
it  by  sending  another,  with  the  same  date,  etc.,  as  the  first, 
marked  *'  duplicate,"  or  "  3d  bill,"  "  4th  bill,"  as  the  case  may 
be ;  for  he  may  not  have  received  the  first,  or  may  have  thrown 
it  aside  with  a  Tra-la-la-la !  or  may  be  purposely  neglecting  it 
in  the  hope  that  you  will  cease  your  claim  forever,  or  trying  to 
let  it  stand  over  till  it  is  forgotten  or  is  out  of  date. 

An  effective  plan  to  adopt  with  a  certain  tardy  class  of 
patients,  when  you  are  in  need  of  money,  is  to  ascertain  the 
date  at  which  you  will  have  a  debt  or  note  to  pay,  or  will  have 
to  raise  money  for  any  other  special  purpose,  and  then  to  write 
a  week  or  two  before  the  time  and  briefly  inform  them  that  you 
will  have  a  special  need  for  money  at  the  time  specified,  and 
ask  them  kindly  to  pay  you  on  or  before  that  date.  Most 
people  of  any  worth  will  exert  themselves  to  comply  with  the 
request,  if  courteously  made.  In  this  manner  you  can  well 
approach  both  your  best  and  your  worst  patients,  and  some  that 
you  cannot  successfully  approach  for  money  in  any  other  way. 
A  request  so  conveyed,  moreover,  shows  that  you  do  not  want 
merely  to  get  it  out  of  their  pocket  into  your  own,  but  that  you 
ask  for  it  because  you  really  happen  to  need  it.  One  who  is  in 
debt  has  always  a  legitimate  excuse  for  sending  in  his  bills  as 
soon  as  his  patients  recover. 

Another  plan,  good  to  pursue  with  those  who  habitually 
throw  bills  aside  and  neglect  to  pay  them,  is  to  send  your 
accounts  some  day  when  you  are  in  need  of  funds,  with  a  brief 
note  asking  them  to  pay  in  the  course  of  the  day,  and  assign 
your  reasons  for  making  so  pressing  a  request.     Even  though 


304  THE   PHYSICIAN    HIMSELF  I 

they  pay  you  nothing  then,  knowing  that  they  have  disap- 
pointed you  in  your  dilemma,  they  will  feel  impelled  at  least  to 
pay  something  on  the  account  when  they  again  need  your  services. 

Also,  using  the  phrase  on  your  bills,  "  Amount  now  on  the 
books  $ ,"  or  "  Balance  still  on  the  books  $ ,"  and  in- 
closing a  brief  note  with  the  bill  of  a  delinquent  for  whom 
you  are  tired  of  waiting,  telling  him  that  his  account  is  greatly 
overdue,  and  asking  him  kindly  to  call  and  settle,  as  you  are 
anxious  to  close  the  account  "  on  the  books,"  remind  him  of 
the  fact  that  it  is  "  on  the  books"  and  overdue,  hence  probably 
seen  and  thought  over  by  you  daily,  and  may  arouse  him  to  the 
extent  of  calling  to  pay,  or  to  make  some  definite  arrangement. 

By  letting  your  prompt-paying  patients  know  in  some  way 
or  other,  at  the  visit  preceding  the  final  one,  that  your  next  visit 
will  be  the  last  that  you  deem  it  necessary  to  make,  it  will  serve 
as  a  gentle  hint  and  afford  them  an  opportunity  to  prepare,  and 
will  greatly  increase  the  chances  of  your  being  paid  cash  at  the 
last  visit.  Convalescents  from  severe  illnesses  who  are  told 
to  pay  you  a  visit  at  your  office  when  able  to  walk  out  again, 
in  order  that  you  may  see  how  they  are  getting  along,  are  very 
apt  to  broach  the  subject  of  your  fees,  and  either  then  pay  or 
make  some  definite  promise  before  leaving. 

You  cannot  put  all  classes  of  bills  on  the  same  footing; 
there  is  mie  class  of  patients  whose  bills  had  better  be  sent  by 
mail,  another  to  whom  they  should  be  taken  by  your  collector 
or  other  person,  (mother  to  whom  you  had  better  deliver  them 
yourself,  and  a  few  promptly-paying  patients  whom  you  had  bet- 
ter allow  to  ask  for  them.  A  careful  study  of  these  facts  will 
be  of  essential  assistance  to  you. 

Items  and  details  are,  as  a  rule,  better  omitted  in  profes- 
sional accounts,  unless  specially  asked  for,  inasmuch  as  they 
tend  to  dissatisfy  people,  and  lead  to  criticisms  and  disputes 
that  would  not  arise  did  not  the  items  furnish  a  pretext.  As- 
sume the  position  that  he  who  confides  in  you  sufficiently  to  put 
the  lives  and  secrets  of  himself  and  family  in  your  keeping  should 


HIS    REPUTATION    AND    SUCCESS.  305 

feel  sufficient  confidence  and  gratitude  to  intrust  you  to  say  Avhat 
value  you  deem  mutually  fair  to  place  on  your  professional  ser- 
vices. In  fact,  a  physician's  bill  that  gives  in  detail  the  various 
items  is  more  apt  to  be  disputed  or  criticised  unless  it  be  unjustly 
small.  Bills  that  simply  state  the  total  amount,  or  "  amount  due 
for  services  since  date  of  last  bill,"  or  -  amount  now  on  the  books," 
are  much  more  likely  to  be  paid  without  dispute.  The  items, 
however,  of  every  bill  should  be  carefully  entered  in  tlie  ledger, 
in  order  that  the  charges  may  be  verified  if  requisite ;  and  each 
and  every  charge  should  rest  on  a  distinct  financial  base  of  its 
own.  Should  a  patient  question  the  accuracy  of  a  non-itemized 
bill,  at  once  concede  his  right  to  be  furnished  with  a  statement 
of  the  number  and  dates  of  visits  and  any  special  services  charged 
for,  or  permission  to  see  the  items  on  the  ledger  should  be  per- 
mitted or  suggested.  But  few  who  would  intrust  you  with  their 
lives  would  push  you  to  this  extent  after  serving  them  faithfully, 
and  these  had  as  well  be  erased  from  your  list  of  patients. 

On  the  payment  of  money  other  than  a  simple  cash  fee  by 
your  patients,  it  is  well  to  msist  on  giving  receipts,  even  though 
they  should  deem  it  unnecessary.  Compelling  every  one  who 
pays  a  debt  that  has  been  booked  to  take  a  receipt  not  only 
prevents  subsequent  disputes,  but  assists  also  in  maintaining  a 
regular  and  desirable  business-like  system  between  you. 

Be  especially  careful  to  avoid  soul-narrowing  avarice  in  its 
various  forms — meanness,  greed,  oppression,  stony  heart — and 
all  other  hateful  extremes.  If  you  attempt  to  shave  too  closely 
in  money  matters, — when  a  patient  is  so  low  that  it  is  no  longer 
decent  to  take  fees,  or  hungrily  hold  watches,  jewelry,  or  other 
articles  as  security  for  the  payment  of  your  fees,  or  compel  their 
owners  to  pawn  or  sell  them  for  your  benefit,  or  charge  interest 
on  your  bills  because  not  promptly  yiaid,  or  be  unreasonable 
(Shylock)  or  too  vigorous  in  your  efforts  to  collect  fees  from 
any  one, — it  would  not  only  be  morally  wrong,  but  would  be 
very  apt  to  prejudice  your  reputation  and  create  a  feeling  of 
hostility  against  you  that  time  could  not  efface. 


306  THE    PHYSICIAN    HIMSELF: 

For  a  like  reason  it  is,  as  a  rule,  better  not  to  charge  for  a 
certificate  of  sickness  furnished  to  patients  to  enable  them  to 
draw  sick-pay  from  clubs  and  other  beneficial  societies,  or  for 
school-children's  certificates  of  vaccination,  etc.  These  should 
be  regarded  as  personal  favors,  differing  from  cases  in  w^hich  a 
fee  is  right  and  proper. 

But  in  every  case  requiring  you  to  go  and  make  an  affidavit 
before  a  court  or  magistrate,  a  moderate  charge  is  proper. 

It  will  seldom  pay  you  to  sue  people,  even  though  your 
suits  be  successful ;  indeed,  it  is,  generally  speaking,  undesirable 
for  you  or  any  other  physician  to  begin  litigation  to  enforce 
your  claims,  except  under  very  aggravating  circumstances  or  to 
maintain  your  reputation  or  self-respect.  Physicians  who  fre- 
quently go  to  law  to  recover  fees  generally  lose  more  in  the  end 
than  the  yield,  by  exciting  prejudice  and  making  enemies.  You 
should  never  resort  to  compulsory  measures  with  any  one  whose 
failure  to  pay  is  due  to  honest  poverty.  While  naturally  seek- 
ing to  get  good  patients,  who  can  and  will  pay  for  your  services, 
be  ever  willing  to  do  your  share  of  charity  for  the  deserving 
poor;  at  the  same  time  the  necessity  of  earning  a  living  for 
yourself  should  make  you  careful  not  to  let  it  crowd  out  your 
remuneratory  practice. 

When  called  upon  to  attend  cases  of  sudden  death,  drown- 
ing, suicide,  persons  found  dead,  murder,  etc.,  in  which  the  un- 
fortunate victim  is  dead  before  you  can  get  to  him,  or  in  calls 
of  emergency,  where  another  physician  reaches  the  patient  and 
takes  charge  before  your  arrival,  or  in  other  cases  where  your 
services  are  not  called  into  action,  or  are  merely  nominal  or 
clearly  useless,  it  will,  as  a  rule,  be  wise  not  to  send  in  an 
account,  as  under  such  circumstances  not  only  would  it  gen- 
erally be  left  unpaid,  but  be  harshly  criticised.  If,  however,  a 
feeling  of  gratitude  induce  the  people  interested  to  tender  you 
fees,  for  your  trouble,  accept  whatever  is  right. 

In  obstinate  and  invincible  maladies,  such  as  hopeless  cases 
of  cancer,  phtliisis,  aneurism,  etc.,  in  which,  after  liaving  gone 


HIS   REPUTATION    AND    SUCCESS.  307 

the  rounds  of  the  profession,  you  are  consulted  m  the  very  last 
stages,  with  the  hope  of  getting  a  new  heart,  or  a  new  pair  of 
lungs,  or  having  other  miracles  performed;  or  merely  to  see 
^vhether  you  can  possibly  do  anything  of  benefit  to  them,  you 
had  better  deal  candidly,  and  frankly  acknowledge  that  you  can 
do  but  little,  or  nothing,  and  decline  the  fee  even  if  tendered. 

It  is  better,  as  a  general  rule,  to  make  no  charge  for  ordi- 
nary or  trifling  advice  incidentally  given  to  patients  when  they 
call  to  pay  their  bill,  or  to  persons  for  whom  you  happen  to  pre- 
scribe in  public  places  (curbstone  prescriptions),  where  you  are 
not  pursuing  your  professional  avocation.  Such  exactions  would, 
to  say  the  least,  tend  to  engender  unpleasant  reminiscences  and 
harsh  criticism.  Every  physician  occasionally  writes  prescrip- 
tions under  circumstances  that,  even  though  he  be  technically 
entitled  to  remuneration,  Ms  own  interests  forbid  his  charging 
or  even  accepting  a  fee  when  tendered. 

Never  make  a  charge  where  the  fee  would  come  from  an- 
other physician's  pocket ;  every  physician  attends  his  professional 
brethren  and  members  of  their  families  gratis.  Some  also- 
attend  clergymen  and  their  families  without  a  charge  of  money^ 
especially  those  with  whom  they  have  church  relations,  and 
those  who  receive  salaries  so  meagre  as  to  make  the  pay- 
ment of  medical  fees  a  hardship.  But  where  a  clergyman  is  in 
the  receipt  of  a  liberal  salary,  and  his  calls  on  you  are  frequent 
or  onerous,  I  know  of  nothing  in  ethics  to  forbid  your  accepting 
from  him  a  fee  voluntarily  tendered.  Some  of  our  best  phy- 
sicians make  it  a  rule  to  charge  half-fees  to  their  own  spiritual 
advisers ;  that  is,  they  make  out  the  bills  for  the  full  amount 
and  receipt  them  upon  payment  of  half  the  sum.  Their  influ- 
ence, if  properly  directed,  is  supposed  to  cancel  the  remainder. 

Never  oppress  any  one  by  exorbitant  fees.  Nearly  every 
one  depends  on  his  physician's  unwatched  integrity,  believing 
that  he  will  be  honest  in  his  conduct,  honest  in  his  treatment, 
and  honest  in  his  charges.  Be  especially  fair  in  your  charges 
against  estates,  and  in  all  other  cases  where  unusual  circum- 


308  THE    PHYSICIAN    HIMSELF: 

stances  place  the  debtor  at  your  mercy.     These  opportunities 
will  fully  test  whether  true  honesty  has  a  seat  in  your  heart. 

"As  a  man  thinketh  iii  his  heart,  so  is  he." 

When  you  are  in  doubt  what  to  charge,  look  upward,  then 
make  out  your  bill  at  such  figures  as  you  may  deem  just  to  the 
patient,  to  the  profession,  and  to  yourself,  and  thus  show  clean 
hands,  morally  as  well  as  antiseptically.  Even-handed  justice 
is  the  basis  of  all  lasting  reputation. 

Great  injury  is  inflicted  on  our  entire  profession  when 
Dr.  Chiselum,  Dr.  Tinchaser,  Dr.  Highprice,  Prof  Twentyfold, 
Dazzlefee,  or  any  other  of  our  guild  places  an  exorbitant 
value  on  his  time  and  labor,  and  charges  those  whom  chance 
has  placed  in  his  power  a  fee  so  enormous  or  outrageously  extor- 
tionate as  to  cause  great  gossip  or  newspaper  notice  of  it.  But, 
carefully  avoid  making  censorious  or  derogatory  comment,  in 
the  presence  of  non-professional  persons,  on  the  fees  claimed  by 
another  physician,  unless  you  are  fully  acquainted  with  all  the 
circumstances,  for  he  may  actually  have  good  and  sufficient 
reasons  for  the  charges  made. 

When  you  and  a  professional  brother  do  each  a  portion  of 
the  work  in  cases  of  accident,  confinement,  etc.,  a  very  fair  plan 
is  to  agree  to  charge  a  joint  fee  and  divide  it.  When  you  re- 
ceive such  a  joint  fee,  go  at  the  earhest  possible  moment  and 
divide  every  dollar,  fairly  and  squarely,  with  your  fellow- worker, 
on  whatever  basis  you  have  agreed  upon. 

When  another  physician  is  called  to  a  case  of  yours,  dur- 
ing your  absence,  not  only  thank  him  at  the  first  opportunity, 
but  also  insist  on  his  sending  his  bill  for  whatever  services  he 
has  rendered.  No  one  can  be  expected  to  work  under  such 
circumstances  without  fee.  His  kindness  to  you  consists  in 
having  responded  to  the  call. 

Never  acknowledge  or  work  under  the  job-lot  fee-table  of 
any  association  or  company,  unless  it  be  in  harmony  with  the 
regular  professional  fee-table  of  your  community. 


HIS   REPUTATION    AND    SUCCESS.  309 

A  fee-table  should  never  be  extravagantly  high  on  one 
hand,  nor  meanly  low  on  the  other,  but  should  be  reasonable  in 
its  tariff,  and  should  always  allow  a  reduction  if  the  patient's 
circumstances  require ;  and  should  also  allow  attendance  on  the 
moneyless  poor  gratis. 

Humanity  requires  you  (as  God's  instrument)  to  go  promptly 
to  all  cases  of  sudden  emergency,  accidents,  and  the  like,  in 
which  the  life  or  limb  of  a  fellow-creature  is  in  jeopardy,  with- 
out regard  to  the  prospect  or  otherwise  of  a  fee.  You  should 
do  various  things  for  the  sake  of  charity ;  among  these  is  to  give 
relief  to  any  one  injured,  or  in  great  pain  or  suffering,  regard- 
less of  fees.  At  such  times  regard  only  Man  in  distress  ;  show 
no  distinction  between  rich  and  poor,  high  and  low,  but  consider 
only  your  simple  duty  to  suffering  humanity.  The  good 
Samaritan  succored  the  wounded  man,  took  him  to  an  inn,  and 
provided  for  his  immediate  necessities.  You,  as  a  physician, 
should  be  equally  humane  and  prompt  to  go  and  bind  up 
wounds,  and  relieve  suffering  in  all  cases  of  emergency.  After 
this  is  done  further  attendance  is,  of  course,  optional,  and  de- 
pends upon  whether  you  choose  to  render  it,  or  feel  that  you  can 
afford  it ;  but  you  are  really  no  more  bound  to  continue  to  attend 
such  a  one  gratuitously  than  the  baker  is  to  give  away  his 
bread  to  the  hungry,  or  the  tailor  to  give  away  his  clothes  to 
the  ragged. 

But,  take  care  never  to  slight  the  worthy  poor,  who  are 
under  the  iron  heel  of  poverty  and  need  medical  attendance.  To 
the  poor  life  and  health  are  everything;  their  very  poverty  and 
lack  of  comforts  make  them  more  likely  to  get  sick  and  to  suffer 
more  in  sickness  than  the  rich,  and  worthy  kindness  to  them  in 
worthy  ways  should  be  as  broad  as  God's  earth.  Besides,  there 
are  none  so  poor  but  that  they  may  amply  repay  your  services 
by  their  earnest  "God  bless  you,  Doctor,"  and  their  genuine, 
lasting  gratitude.  Besides,  how  heartfelt  and  pure  the  gratifica- 
tion to  wrest  a  fellow-being  from  destruction ! 

Physicians  render  more  gratuitous  and  unpaid  services  than 


310  THE    THYSICIAN    HIMSELF: 

any  other  class  of  people  in  the  world.  Allowing-  that  there  are 
in  the  United  States  fifty  thousand  regular  practicing  physicians, 
and  that  each  does  one  hundred  dollars'  worth  of  lahor  to  charity 
practice  a  year, — which  is  far  below  the  average, — we  have  the 
enormous  sum  of  five  millions  of  dollars  of  charitable  labor 
given  by  its  medical  profession  every  year. 

"  The  poor,"  said  Boerhaave,  "  are  my  best  patients.  God 
will  be  their  paymaster."  But  even  in  dispensing  charity,  care- 
ful discrimination  is  essential.  There  would  seem  to  be  three 
classes  of  the  poor, — the  Lord's  poor,  the  devil's  poor,  and  the 
poor  devils.  The  first  and  last  are  worthy  objects  of  every  phy- 
sician's attention,  and  you  would  do  well  to  lose  no  opportunity 
to  give  relief  to  their  ailments.  The  less,  however,  you  have  to 
do  with  the  other  class  {the  devlVs poor),  and  the  less  health 
and  strength  you  waste  on  them,  the  better  for  you;  neverthe- 
less, you  will  be  more  or  less  compelled  to  attend  more  than  you 
would  otherwise  care  to  do  of  the  lowest  and  vilest  victims  of 
vice,  intemperance,  and  sensual  indulgence, — who  are  perhaps 
a  curse  to  their  families  and  a  nuisance  to  the  neighborhood, — 
and  watch  over  them  as  faithfully  as  if  they  were  noblemen ; 
some  for  God's  sake,  and  others,  it  may  be,  on  account  of  their 
relationship  to  better  and  more  provident  patients ;  you  will 
generally  find,  however,  that,  "  though  this  citizen  and  that 
fellow  may  be  brothers,  their  pocket-books  are  not  sisters." 

It  is  your  duty  to  raise  your  voice  in  the  profession  against 
the  fearful  abuse  of  medical  charities  by  the  people,  and  the 
largely  increasing  numbers  of  free  special  dispensaries,  college 
clinics,  and  the  out-door  departments  of  hospitals,  church  infirm- 
aries, and  private  retreats,  which,  of  late,  under  the  color  of 
charity,  attract  not  only  aching  beggars  from  squalid  streets  and 
alleys,  drunken  and  worthless  men's  families,  the  poverty-stricken 
sick  and  humble  people  out  of  employment,  whose  forlorn  aspect 
is  unmistakable,  but  also  thousands  of  stingy  impostors  and 
miserly  drones,  who  are  ahundantJjj  able  to  pay  for  medical 
services;  and,  which,  still  worse,  offer  a  refuge  in  their  rainy 


HIS   REPUTATION    AND    SUCCESS.  311 

day  to  the  lazy  and  vicious,  against  which,  the  latter,  conse- 
quently, need  not  provide  by  industry,  sobriety,  and  economy. 
Make  a  person  a  pauper,  or  encourage  him  to  become  a  lazy 
beggar,  or  destroy  his  independence  and  manhood  in  one  thing, 
and  he  is  apt  to  degenerate  and  become  improvident  and 
worthless  in  many. 

No  member  of  the  profession — and  the  same  may  be  said 
of  pharmacists  and  physicians  who  keep  drug-stores  and  pre- 
scribe over  their  counters — has,  in  the  spirit  of  common  justice, 
a  right  to  give  professional  services  to  the  public  without  fee, 
except  to  the  moneyless  poor  (to  whom  they  should  be  rendered 
in  the  holy  name  of  charity,  as  freely  as  the  air  they  breathe) ; 
for,  although  there  may  be  no  loss  thereby  to  him  personally,  it 
has  a  pauperizing  tendency  on  a  certain  class  of  people,  and  is 
taking  bread  from  the  mouths  of  struggling  physicians  by  mo- 
nopolizing practice  that  would  otherwise  fall  into  their  hands, 
and  to  that  extent  it  is  despoiling  the  profession  of  its  legitimate 
fees. 

Glory  built  on  selflsli  principles  is  shame  and  guilt. 

Thousands  of  young  and  deserving  sons  of  ^sculapius 
have  been,  of  late,  cheated  out  of  what  would  be  to  them  bread 
and  a  slender  support,  and  a  chance  to  get  into  practice,  by  so- 
called  "  Hospital "  or  "  Church  "  Charities,  carried  on  chiefly  in 
the  interest  of  individuals,  or  coteries,  who,  to  foster  reputation 
in  their  specialties,  and  to  outstrip  rivals,  treat  everi/hody  that 
applies, — the  rich,  the  poor,  and  the  intermediate  class, — whether 
entitled  to  the  benefits  of  their  charity  or  not,  without  tlie  slightest 
regard  to  the  interest  of  other  medical  men,  or  their  desire  to  do 
a  share  of  charity. 

Immortal  gods  1     Such  stony  injustice 
Blots  all  the  heaven-born  features. 

The  ultimate  result  of  this  state  of  things  will  be  either  that 
the  profession  will,  in  self-defense,  be  compelled  to  organize 
self-preservation  associations,  or  tliat  individual  physicians  will 
take  up  the  case  and  resolve  neither  to  turn  over  cases  to  nor 


312  THE   PHYSICIAN    HIMSELF  I 

to  call  into  consultation  any  specialist,  professor,  or  surgeon  who 
continues  to  render  gratuitous  service  to  those  who  are  able  to 
pay  for  it.  The  last-mentioned  course  would  probably  influence 
the  transgressors  strongly.  THE  SHAMEFUL  WRONG 
DONE  to  the  profession  by  such  institutions  lies  not  so  much 
in  the  working  of  the  hospitals  themselves,  but  IN  the  conduct 
of  THEIR  DISPENSARIES  AND  OUT-DOOR  DEPART- 
MENTS. 

Probably  a  considerable  proportion  of  the  impostors  and 
frauds  able  to  pay  for  services,  who  impose  on  these  institutions, 
knowing  the  risk  of  being  unearthed  and  turned  away,  would 
shrink  from  venturing  such  exposure  to  the  public  by  the 
prominent  display  of  some  such  sign  as  the  following:  "This 
Dispensary  is  for  the  moneyless  poor  only." 

Bear  in  mind,  for  an  individual  to  advertise  gratuitous 
attendance  on  the  poor  at  his  office,  or  at  certain  times,  or  under 
certain  conditions,  is  unprofessional. 

Found  your  ideas  of  Christian  duty  and  of  doing  charity 
on  the  fifth,  sixth,  and  seventh  chapters  of  Matthew  and  the 
thirteenth  chapter  of  First  Corinthians,  and  you  cannot  go  far 
astray. 

"  Prompt  payments  are  appreciated  by  everybody "  is  a 
very  useful  maxim  to  have  printed  on  the  margin  of  your  bills; 
it  is  truthful,  and  gives  thanks  to  those  who  pay  promptly.  To 
those  who  do  not  it  serves  as  a  neat  admonition. 

The  size  of  the  house  does  not  always  show  the  size  of  the 
owner's  honesty.  You  will  find,  in  the  course  of  your  profes- 
sional career,  that  honesty  and  dishonesty  are  not  confined  to 
any  one  nationality  or  to  any  station  in  life,  but  that  there  are 
many  very  good  men  and  others  equally  bad  among  the  rich 
and  poor  alike.  You  will,  perhaps,  mount  many  a  marble 
step,  puU  many  a  silver  bell-knob,  and  walk  over  many  a  velvet 
carpet  for  well-housed,  sumptuously  fed,  fashionably  clothed, 
diamond-studded  patients, — 

"  "With  the  manners  of  a  marquis," — 


HIS    REPUTATION    AND    SUCCESS.  313 

who  will  turn  out  unscrupulously  fraudulent,  and  at  the  same 
time  you  will  get  many  an  honest  fee  from  others  who  make  no 
great  pretensions  and  possess  but  little  save  their  truly  honest 
hearts ;  it  will  touch  you,  to  see  these  come  with  part  of  their 
small  pittance  to  share  it  with  you.  Others,  who  know  what  it 
cost  to  get  what  they  have,  know  how  to  hold  it,  and  the 
demands  of  fashion  are  now  so  great  on  those  who  are  trying 
to  keep  up  with  it,  that  many  with  moderate  incomes  habitually 
ignore  their  physicians'  bills  in  order  to  aid  in  keeping  up  ap- 
pearances of  being  worth  more  than  they  are.  You  will  see 
many  a  man  bowed  down  with  debt  and  despondency,  while  his 
trinketed  wife  and  dazzling  daughters  parade  about  as  gay  and 
as  fine  as  strutting  peacocks,  indebted  to  everybody  and  paying 
nobody.  Artful,  double-dealing  w^omen  will  sometimes  actually 
intercept  your  bills  and  make  it  impossible  for  you  to  solicit 
payment  from  their  husbands,  unless  you  resort  to  strategy  and 
get  your  bills  delivered  direct  to  the  latter ;  and  will  even  then 
enter  the  field  of  falsehood  and  do  everything  they  can  to  defer 
or  altogether  prevent  payment. 

Families  will  occasionally  conceal  from  the  person  who 
holds  himself  responsible  for  your  bill  the  true  amount  of  ser- 
vice you  have  rendered,  or  the  actual  number  of  visits  you  have 
paid,  and  thereby  lead  him  to  think  you  have  charged  very 
high,  or  even  exorbitantly.  Be  prepared,  therefore,  promptly  to 
correct  such  errors. 

The  most  unsatisfactory  and  troublesome  kind  of  patients 
physicians  have  to  contend  with  are  the  unprincipled  tricksters^ 
who,  wholly  void  of  moral  sense,  cheat  everybody  that  affords 
them  a  chance,  and  consider  it  only  an  honorable  transaction  to 
victimize  physicians,  and  would  not  cross  their  fingers  to  keep 
us  from  going  to  the  almshouse.  You  will  be  fortunate  if  you 
have  sufficient  tact  to  avoid  having  anything  to  do  with  those 
who  belong  to  this  class.  It  is  far  better  courteously,  but  firmly, 
to  decline  to  accept  as  patients  those  who  can  but  will  not 
pay,  without  assigning  any  reason,  except  that  you  are  "  too 


314  THE    PHYSICIAN    HIMSELF: 

hiisi/,^'  or  "/'r/  rather  you  would  consult  someone  else,''  than 
to  have  to  wrangle  with  them  about  your  fees  after  your  work 
is  done,  and  maybe,  after  all,  get  neither  fees  nor  thanks. 

Have  your  wits  about  you,  and  tell  Hardnut,  Spendall, 
Dedbroke,  Poormouth,  BlufFum,  Codiisli,  and  other  habitual 
delinquents,  who  have  plenty  of  money  to  smoke  expensive 
cigars,  go  to  places  of  amusement,  buy  beer,  or  fill  the  brandy- 
bottle,  or  to  furnish  their  houses  like  palaces,  or  to  follow  the 
follies  of  fashion,  but  none  to  pay  the  physician, — when  they 
have  the  temerity  to  come,  with  lamentations  and  a  hatful  of 
excuses,  to  increase  their  indebtedness, — that  they  are  already 
as  largely  indebted  to  you  as  you  can  afford  to  let  them  be,  but 
that  you  are  perfectly  willing  to  serve  them  again  after  they 
pay  you  what  is  already  on  the  books,  or  a  reasonable  part  of 
it,  or  if  they  will  pay  you  for  the  new  services  cash  at  each 
visit ;  and  base  your  position  in  the  matter  not  so  much  on  the 
fact  that  they  are  in  question,  as  that  you  are  acting  in  accord- 
ance with  a  regular  rule.  Such  attitude  on  your  part  will  very 
probably  lead  to  some  more  or  less  satisfactory  action  on  theirs, 
and  thus  indicate  to  you  what  course  to  pursue. 

In  dunning  delinquents  for  fees,  it  is  better  to  charge  them 
with  carelessness  in  the  matter  of  paying,  than  with  dishonesty. 

You  will  encounter  many  a  person  who,  although  quite 
amiable  during  your  attendance,  will  prove  very  different — 
maybe  as  sensitive  as  the  eyeball — when  your  bill  is  presented ; 
then, — 

"  Oh,  such  vinegar  aspect !  " 

In  such  cases,  take  especial  care  to  give  no  cause  for  fault- 
finding with  your  mode  of  presenting  it.  It  is  a  useful  precau- 
tion to  inclose  each  bill  sent  by  mail  or  messenger  in  a  half- 
sheet  of  blank  paper,  so  as  to  prevent  prying  custodians  from 
peering  through  the  envelope  and  recognizing  its  contents. 

When  possible,  let  your  bills  be  presented  direct  to  the 
party  financially  responsible,  or  to  the  real  head  of  the  family, 
and  say  nothing  about  them  to  other  members  of  the  household. 


flIS    REPUTATION   AND    SUCCESS.  315 

In  spite  of  all,  were  you  a  Solomon  and  an  Angel  com- 
bined, many  patients  will  find  fault,  show  ill-temper,  and  meanly 
quit  you,  under  one  pretence  or  another,  when  you  send  your 
bill  or  ask  for  your  fee,  no  matter  how  or  when  you  do  it. 

A  moderately  successful  practitioner  has  about  two  thou- 
sand persons  who  call  him  tJieir  "  doctor  "  (fully  three  hundred 
of  whom  are  moneyless  or  bad  pay) ;  and  whenever  any  one 
of  these  is  suffering  from  mental  or  physical  ailment,  he  must 
share  it  by  head-work  and  hand-work  and  heart-work.  He 
must  combine  all  good  qualities,  and  appear  the  perfection  of 
each  to  all  men,  must  be  bold  as  a  lion  with  one  patient,  as 
patient  as  an  ox  with  another,  and  as  gentle  as  a  lamb  with  the 
next.  Self-sacrificing,  his  own  aches  and  pains  must  be  con- 
cealed or  go  unnoticed, — 

"It  is  a  fortunate  head  that  never  aches," — 

and,  being  the  slave  of  the  sick  public,  he  must  face  contagious 
disease  and  inhale  noxious  vapors,  miasms,  and  malaria;  en- 
counter the  filthiest  kind  of  filth  and  the  worst  of  all  stinks, 
and  perform  many  distasteful  and  disagreeable  and  disgusting 
duties,  amid  embarrassments,  disappointments,  and  vexations. 

"None  but  a  physician  knows  a  physician's  cares." 

He  must  endure  all  temperatures, — August  suns  and  December 
blasts ;  drowned  with  the  rain  and  choked  by  the  dust,  he  must 
trudge,  hungry  and  sleepy,  at  noon  or  midnight,  while  others, 
oblivious  to  care,  are  resting,  or  being  refreshed  with  sleep  ;  must 
be  with  families  at  all  seasons,  in  death  and  recovery,  in  sorrow 
and  joy.  A  soldier  may  serve  his  whole  term  witliout  smelling 
powder  or  even  getting  within  long  range  of  danger.  A  phy- 
sician is  in  continual  danger,  and  when,  like  a  wild  and  relentless 
tornado,  the  swift,  gaunt,  ghastly,  withering  epidemic  begins  its 
work  of  death,  no  matter  how  great  the  danger,  he  cannot 
£ee  but  in  dishonor, — no  personal  considerations,  no  domestic 
relations,  no  plea  whatever  can  excuse  him, — but  he  must  depend 
on  Providence,  and,  from  pure  love  of  humanity,  take  his  life 


■ 


316  THE   PHYSICIAN    HIMSELF: 

in  his  own  hands,  hazard  the  danger,  and  stand  (hke  Aaron) 
between  the  living  and  the  dead,  in  localities  filthy  and  ill- 
ventilated,  to  fight  the  monster  — 

"  With  aspect  stern  and  gloomy  stride  " — 

face  to  face,  even  though,  without  reward  or  expectation  of 
reward,  he  sufier  martyrdom  in  the  conflict,  while  thousands 
are  falling,  like  sheep,  around  him,  and  other  terror-stricken 
thousands  are  fleeing  for  their  lives !  He  must  have  an  eye 
like  an  eagle's,  a  heart  like  a  lion's,  and  a  hand  like  a  lady's, 
— must  combine  all  good  qualities,  and  appear  the  perfection  of 
each  to  all  men,  and,  heaven  knows  !  from  the  narrowness, 
and  crookedness,  and  steepness,  and  roughness  of  his  life's  road, 
he  deserves  far  more  generous  treatment,  and  a  much  more 
comfortable  support,  than  he  receives. 

Some  one  has  divided  man's  life  into  four  periods,  and 
called  the  first  twenty  years  the  period  of  preparation  ;  from 
twenty  to  forty,  the  period  of  struggle ;  from  forty  to  sixty,  the 
period  of  victory;  and  after  sixty,  rest.  No  fourth  period  for 
the  physician  ;  his  struggle  lasts  (if  he  is  able  to  walk,  to  see,  or 
to  hold  a  pen)  until  his  life  ends. 

How  nice  it  would  be  if  a  physician  could  retire,  with 
honors  and  a  competence,  at  sixty,  and  leave  the  path  open  for 
other  and  younger  men  ! 

"  A  youth  of  labor  with  an  age  of  ease." 

Computed  by  the  ten-hour  system,  every  busy  physician 
does  no  less  than  five  hundred  days'  work  a  year,  loses  much 
sleep  and  many  meals,  and  has  to  serve  numerous  masters  at 
all  hours,  from  sunrise  to  sunrise.  Every  year,  measuring  by 
Avork,  vexations,  anxieties,  discouragements,  and  care,  the  aver- 
age practitioner  has  three  years  of  brain-work  and  mental  strain, 
has  to  endure  all  kinds  of  criticism,  does  more  charity,  and  then 
lets  his  accounts  against  those  who  are  able  to  pay  run  longer 
than  any  other  person  in  the  whole  community. 

The  trades  and  common  occupations  are  learned  in  three  or 
four  years ;  perfection  in  them  is  then  reached,  and  the  balance 


HIS    REPUTATION  AND    SUCCESS.  317 

of  life  is  simply  a  routine  employment ;  not  so  with  us,  for  in 
medicine  the  law  is  progress,  perfection  is  never  reached,  and 
study  and  mental  exertion  are  never  done. 

New  discoveries  teach  new  duties. 

The  fact  that  a  physician  has  to  keep  up  an  external  show 
of  prosperity,  and  that  many  pay  their  visits  with  gloved  hands 
and  in  stylish  carriages,  leads  not  a  few  unreasoning  persons  to 
infer  that  ours  is  a  path  of  ease,  almost  a  bed  of  roses ;  that  we 
drive  about  during  bank-liours,  prescribe  for  a  few  select 
patients,  receive  fees  by  wholesale,  and  soon  get  rich  enough 
to  retire  and  live  on  the  interest;  all  which  is  a  very  great 
mistake.  On  the  contitiry,  every  older  physician  knows  that 
after  working  hard  day  and  night,  owing  to  the  difficult  collec- 
tions and  the  large  proportion  of  the  poor,  the  practice  of  med- 
icine is  neither  an  Eldorado  nor  a  money-making  profession, 
and  that  it  is  almost  impossible  to  get  rich  by  the  practice  of 
medicine,  unless  one  have  extraordinary  professional  skill  and 
repute,  or  be  a  celebrated  surgeon,  commanding  great  fees;  or 
a  fashionable  favorite,  lucky  enough  to  attend  groups  of  patients 
who  have  copious  and  open  purses,  or  a  leading  speciaHst, 
charging  what  he  pleases — 

"Their  hens  lay  eggs  with  double  yelks." 

In  fact,  I  know  of  no  legitimate  business  in  which  the  same 
amount  of  capital  and  time  laid  out,  and  labor,  industry, 
and  prudence  exercised,  would  not  be  likely  to  prove  much 
more  lucrative.  Other  men, — the  farmer,  the  merchant,  the 
mechanic,  and  the  artisan, — successful  in  their  pursuits,  can 
increase  their  business  to  any  extent  by  employing  additional 
liands  and  superintendents.  A  physician  does  nothing  by 
proxy,  and  must  undertake  no  more  than  he  can  do  personally, 
and  has  no  gains  but  from  his  own  individual  efforts.  Besides, 
the  expense  of  living  and  the  cost  of  library  and  apparatus 
have  all  greatly  increased  within  the  last  few  years,  and  the 
fees  for  services  have  certainly  not  advanced  in  the  same  ratio. 


318  THE   PHYSICIAN    HIMSELF: 

The  income  of  the  most  successful  physicians  is  far  below 
what  is  commonly  imagined,  and  many  a  physician  is  in  a 
constant  state  of  poverty  and  debt,  even  after  economising  in 
every  direction  and  foregoing  the  purchase  of  many  books  and 
instruments  which  he  actually  needs.  Besides,  ours  is' not  a 
long-lived  profession,  and  many  a  conscientious,  able,  time-worn 
physician  dies,  and,  instead  of  bequeathing  an  Aladdin's  lamp, 
leaves  those  dependent  upon  him  poor  and  helpless,  unless  he 
has  acquired  money  otherwise  than  by  his  practice. 

After  his  death,  a  physician's  outstanding  bills  are  rarely 
collectable.  Many  a  one  with  a  large  practice  dies,  his  poor 
family  inherits  only  a  book  of  worthless  accounts,  and  his 
estate  is  found  to  be  scarcely  worth  administering  on  ;  as  if  they 
had  spent  their  lives  in 

"  Dropping  buckets  into  empty  wells, 
And  growing  old  in  drawing  nothing  out." 

According  to  the  mortality  tables,  the  average  of  the  lives  of  phy- 
sicians is  fifty-six  years.  If  you  begin  practice  at  twenty-four, 
your  active-life  prospect  will  be  thirty-two  years,  and  from  a 
thousand  to  fifteen  hundred  dollars  will  represent  your  average 
yearly  income. 

"Facts  are  stubborn  things." 

Now,  were  you  (through  God's  mercy)  to  practice  these 
thirty-two  years  without  losing  a  single  day,  and  collect  (say) 
eight  dollars  every  day  of  the  time,  you  would  receive  but 
ninety-three  thousand  four  liundred  and  forty  dollars.  Deduct 
from  that  amount  your  expenses  for  yourself  and  family,  your 
horses,  carriages,  books,  periodicals,  and  instruments ;  your 
taxes,  insurance,  and  a  multitude  of  other  items  for  the  whole 
thirty-two  years,  and  then,  so  far  from  being  rich,  even  after 
this  long  and  active  life  of  usefulness  in  our  important  and 
honorable  profession  ;  yea !  after  a  whole  life-time  of  scientific 
work,  mental  toil,  and  of  slavery  to  our  unrelenting  taskmaster, 
The  Sick  Public ;  from  the  days  of  the  dirty,  unwholesome  dis- 
secting-rooms through  all  life's  phases  to  old  age ;  with  not  even 


HIS    REPUTATION    AND    SUCCESS.  319 

the  Sabbaths  to  call  your  own, — when  your  harvest  is  past  and 
your  summer  is  ended  you  will  have  but  little,  very  little,  left 
to  support  you  when  you  reach  the  down-hill  of  life,  or  are 
broken  down  in  health,  with  memory  worn  out,  eyes  dim,  arms* 
strength  and  hands'  cunning  lost,  other  faculties  deteriorated^ 
unfit,  unable  to  work,  and  in  need  of  a  physician  yourself. 

"  Thus  they  who  reach 
Gray  hairs  die  piecemeal." 

The  physician  is,  as  a  rule,  so  poor  a  man  of  business 
that  if  he  receives  money  enough  to  meet  his  necessities  he 
is  but  seldom  troubled  about  the  balance.  Money  comes, 
money  goes,  and  he  saves  nothing.  The  writer  had  a  friend,  a 
strong  man  and  an  excellent  physician,  who  detested  keeping- 
accounts,  and  was  so  neglectful  about  his  fees  that  he  kept  no 
systematic  register  of  charges  and  payments  whatever,  trusted 
all  to  his  memory,  and  rarely  sent  a  bill ;  the  result  was  that 
his  easy  and  convenient  terms,  together  with  his  superior  skill, 
made  him  extremely  popular,  and  brought  him  more  business 
than  he  could  do  justice  to,  and  kept  him  overworked  day  and 
night,  until,  at  the  end  of  fourteen  years,  the  incessant  fatigue, 
exposure,  anxiety,  and  crowding  cares  of  his  overgrown  prac- 
tice ran  him  off  his  legs,  broke  down  his  giant  strength,  and 
he  died,  almost,  as  it  were,  by  suicide,  leaving  his  starving  wife 
and  unfed  children  without  a  dollar — yes !  nothing — exce])t 
painful  regret  at  his  improvidence  and  lamentable  lack  of  busi- 
ness system.  He  was,  indeed,  the  "pet  of  the  town  "  while  he 
lived ;  but  how  fared  his  wife  and  children  after  his  life's  work 
was  over'? 

Be  it  your  duty  to  self  and  to  others  to  guard  against  such 
a  system,  or,  rather,  lack  of  system ;  for,  while  you  owe  certain 
duties  to  your  patients,  you  also  owe  some  to  yourself  and  some 
to  your  family,  if  you  have  one,  and  no  man  should  ever  sacrifice 
and  neglect  either  department  for  the  other. 

One  would  suppose  that  physicians,  whose  lives  are  spent 
in  preventing  and  curing  disease  in  others,  might  themselves 


320  THE    PHYSICIAN    HIMSELF: 

claim  exemption  from  disease  and  decay  ;  might  turn  aside  from 
their  own  bosoms  the  arrows  which  their  skill  has  turned  aside 
from  so  many  others,  and  attain  unusual  longevity ;  but  not  so. 
On  the  scroll  of  the  Icy  King  of  Terrors  we  are  but  men  like 
other  men,  and  have  no  exemption  from  the  common  lot;  are 
bound  by  the  same  laws  of  mortality,  and,  subject  to  perpetual 
wear  and  tear  of  body  and  mind ;  we  suffer  sickness,  we  are  de- 
prived of  health,  our  bosoms  receive  the  shaft,  and  we  pay  the 
natural  debt,  and  fill  an  early  grave  fully  as  often  as  other  men. 

"  Death  ! — great  proprietor  of  all — 
Will  seize  the  Doctor  too." 

Remember  that  other  business-men's  resources  and  produc- 
tiveness survive  their  death  or  outlast  their  ability  to  work,  while 
a  physician's  gains  represent  nothing  more  stable  than  his  indi- 
vidual capacity  for  labor,  and  end  when  he  does ;  tlierefore, 
while  you  are  young  and  healthy  determine  to  put  away  part 
of  your  income  as  a  nest-egg  for  a  rainy  day,  or  to  fall  back  on 
in  sickness,  or  when  old  and  tired  of  occupation ;  for  no  one 
knows  what  ill-luck  may  overtake  him  in  the  course  of  life,  or 
how  dire  may  sometime  be  his  need  for  money ;  furthermore, 
even  if  one  is  lucky  enough  to  remain  healthy,  it  is  the  dollars 
saved  during  the  first  years  of  practice  that  roll  up  into  future 
competence. 

"For  age  and  want,  save  while  you  may." 

Besides,  if  your  death  would  leave  your  loved  ones  other- 
wise unprovided  for,  it  would  be  wise  and  reasonable  to  take 
time  by  the  forelock  and  provide  for  them  by  a  sufficient  assur- 
ance on  your  life,  which  can  be  gotten  and  maintained  at  a 
small  cost ;  then,  if  you  should  be  taken, 

"The  widow's  heart  shall  sing  for  joy, 
The  orphans  shall  be  fed." 

Beware  of  investing  your  earnings  in  popular  speculations, 
and  refuse  to  go  security  for  other  people's  debts,  etc.  Phy- 
sicians are  notoriously  unfortunate  in  such  ventures,  and  they 


HIS    REPUTATION    AND    SUCCESS.  321 

have  caused  many  of  our  number  to  end  their  days  disappointed 
and  moneyless,  instead  of  in  comfort  with  a  competence. 

A  good,  honest  collector — one  who  possesses  judgment  and 
sufficient  tact  to  wake  up  hard  customers  and  get  money  on  an 
easy  installment,  or  other  plan,  from  reluctant  and  dilatory  debt- 
ors without  irritating  and  converting  them  into  active  enemies 
— will  be  found  very  useful,  and  is  quite  necessary  if  you  be 
too  tender  or  too  high-spirited  to  allow  a  direct  transfer  of 
remuneration  from  old  friends  or  refined  patients,  or  if  you 
have  no  time,  or  are  an  indifferent  collector  yourself  Having 
only  business  transactions  with  patients,  his  interviews  with 
them  are  business  exclusively^  and  he  can  persevere  in  his  eff'orts 
to  collect  to  a  degree  that  you  would  find  unpleasant  or  humili- 
ating. Many  thoroughly  honest  people  are  too  poor  to  pay  large 
bills,  and  if  you  allowed  their  account  to  accumulate  from  time 
to  time  into  a  large  bill  they  would  be  unable  to  pay  it,  even 
if  they  wished,  and  consequently  you  would  place  them  in  a 
position  of  embarrassment.  Having  a  collector  prevents  this  and 
keeps  one's  financial  department  in  a  healthy  condition.  It  also 
tends  to  stimulate  those  w^ho  are  habitually  slow  of  payment,  and, 
at  the  same  time,  sifts  out  undesirable  patients  and  erases  their 
names  from  your  list  before  they  run  their  bills  very  high. 

You  should  have  some  specific  agreement  with  your  col- 
lector, not  only  in  regard  to  his  rate  of  percentage  for  collecting, 
but  also  as  to  the  conditions  under  which  he  is  to  claim  it. 
Among  other  things,  you  should  stipulate  that  he  is  to  make 
full  returns  to  you  once  a  week,  or,  at  least,  once  a  fortnight ; 
that  he  is  to  have  no  percentage  on  money  paid  to  you  by  those 
whom  he  has  not  visited  for  a  month,  unless  you  have  at  their 
request  stopped  him  from  calling ;  and  that  he  is  to  receive 
nothing  on  bills  placed  in  his  hands  if  the  indebted  parties 
call  and  pay  before  he  has  delivered  their  bills ;  in  fact,  nothing 
on  any  bill  which  he  does  not  in  some  way  assist  in  collecting. 

It  is  wise  to  post  your  books,  make  out  bills,  settle  with 
your  collector,  and,  in  fact,  to  conduct  all  the  features  of  your 


322  THE   PHYSICIAN    HIMSELF: 

pecuniary  department  as  much  out  of  public  sight  as  possible^ 
so  that  the  pubUc  may  know  little  or  nothing  about  you  except 
as  a  medical  attendant. 

If  you  adopt  some  special  shade  or  color  for  your  bills,  it 
will  not  only  make  them  easy  to  find  when  patients  mingle  them 
with  others,  but  will  also  remind  those  who  are  remiss  or  tardy 
in  paying  the  debt,  every  time  the  color  arrests  their  attention, 
and  may,  by  thus  constantly  reminding  them,  actually  secure  or 
accelerate  payment. 

The  publication  of  lists  (black-lists)  of  the  names  of  fraud- 
ulent patients  among  physicians  practicing  in  a  given  area  is 
mutually  profitable,  as  it  is  a  means  of  debarring  those  who  can 
pay  if  they  wish  from  systematically  imposing  on  a  succession 
of  physicians,  and  coercing  them  into  paying  and  retaining 
some  one.  From  such  lists  the  deserving  poor,  unable  to  pay, 
should  always  be  omitted. 

A  good  way  to  get  up  "  The  Physicians'  Protective  Alli- 
ance "  is  to  have  a  meeting  of  the  physicians  of  your  section, 
and,  after  organizing,  appoint  a  Publication  Committee,  to 
which  every  member  shall,  within  a  specified  time,  hand  a  list 
of  the  names,  occupations,  and  addresses  of  able-to-pay  patients 
who  have,  through  apparent  carelessness  or  lack  of  good  prin- 
ciple, owed  them  bills  nnjiistly  long. 

All  these  names  should  be  alphabetically  arranged  and 
published,  in  a  small,  plain,  blue,  cloth-bound  "  Reference 
Book,"  one  copy  for  each  member.  Also,  have  to  accompany 
each  book  a  separate  printed  slip,  containing  the  name  of  each 
physician  who  has  given  a  list,  with  the  number  assigned  to  him 
by  the  committee  placed  before  his  name : — 

1.  Dr.  John  Allen, 

2.  Dr.  Henry  Blair, 

3.  Dr.  William  Curry,  etc. ; 

these  slips  to  be  kept  sacredly  private,  and  seen  by  their  owners 
only.  Suppose  Dr.  James  Shaw  is  No.  16  and  Dr.  Thomas 
Wilson  is  No.  31   on  the  slip  or  key.     We  find  among  the 


REPUTATION    AND    SUCCESS.  323 

delinquents  the  name  of  Samuel  Adams,  plasterer,  No.  127 
N.  Bond  Street,  with  16  behind  it.  This,  of  course,  shows  that 
Samuel  Adams  has  been  careless  or  unjustly  slow  in  paying-  No. 
16  (Dr.  Shaw)  a  bill  that  he  owes.  If  16  and  31  both  appear 
behind  his  name,  it  shows  that  he  is  in  bad  standing  with  both 
Drs.  Shaw  and  Wilson,  and  has  been  reported  by  both.  The 
object  of  such  an  association  should  be:  not  to  forbid  any  one 
who  chooses  to  attend  to  delinquents  from  doing  so,  but  simply 
to  tell  one  another  of  them,  so  that  any  one  may  either  decline 
to  attend  them  or  do  so  with  his  eyes  open. 

The  list  of  names  in  the  book  should,  for  obvious  reasons, 
follow  some  such  inoffensive  title  as : — 

The  Physician's  Protective  Alliance. 

"Buffalo,  N.  Y.,  January  1,  1893. 

"  The  following  is  a  list  of  persons  who,  through 
apparent  carelessness  or  lack  of  just  principle,  have  been  in- 
debted to  various  physicians  unjustly  Jong : — 

"Adams,  Samuel,  plasterer,  127  N.  Bond  Street,  16. 

"  Bowman  Daniel,  engineer,  479  W.  Biddle  Street,  23,  44." 

Every  two  or  three  years  a  new  volume  should  be  gotten 
up  and  issued. 


CHAPTER  XII. 

"The  more  one  believes  in  the  possibility  of  error, 
the  surer  will  he  be  to  avoid  mistakes." 

Be  alert,  observant,  and  apprehensive.  You  will  be  sup- 
posed to  foreknow  all  conceivable  things  relating  to  disease,  its 
dangers  and  its  terminations ;  therefore  never  exhibit  self -accus- 
ing surprise  at  any  possible  event  growing  out  of  sickness. 
Even  when  cunning  death  has  unexpectedly  visited  some  one 
under  your  treatment,  either  directly  or  as  a  coincidence,  do  not 
let  your  manner  or  expressions  indicate  that  you  were  altogether 
ignorant  of  its  possibility,  or  that  you  regard  yourself  as  deserving 
of  blame,  since  every  case  has  not  only  its  probabilities,  but  also 
its  possibilities. 

When  you  are  attending  cases  in  which  there  is  danger  of 
rapid  or  sudden  death,  beware  of  ordering  chloral,  opiates,  or 
other  potent  drugs  in  such  a  manner  as  to  create  a  belief  that 
they  have  caused  or  hastened  death  (manslaughter).  Circum- 
stances or  fear  of  coincidence  may  at  times  even  render  it  judi- 
cious to  avoid  writing  a  prescription  at  all,  and  simply  to  order 
this  or  that  appropriate  remedy  under  its  common  name,  so  that, 
its  suitableness  to  the  case  and  its  innocuous  nature  being 
understood  by  all,  you  may  not  be  unjustly  charged  with  doing 
harm  with  it. 

When  any  one  under  your  treatment  sinks  unexpectedly, 
or  dies  mysteriously,  or  shortly  after  the  use  of  some  agent  that 
you  have  directed,  or  after  the  administration  of  some  new 
remedy,  or  shortly  after  you  have  performed  some  operation,  or 
soon  after  you  have  pronounced  him  better, — 

"Joy  and  sorrow  are  next-door  neighbors," — 

or  in  any  other  way  that  could  possibly  subject  you  to  unjust 
imphcation  or  blame,  it  is  better  quietly  but  resolutely  to  make 
a  visit  to  the  house  of  mourning,  with  a  view  to  ascertain  the 
(324) 


HIS    REPUTATION    AND    SUCCESS.  325 

cause  of  death,  and  also  to  discover  what  attitude  the  friends 
assume  toward  you,  and  to  meet  their  criticisms  and  protect 
yourself  by  explanations,  etc.  On  such  occasions  you  cannot 
be  too  calm  and  self-possessed,  nor  too  well  prepared  to  explain, 
and,  if  necessary,  defend  your  course  and  the  treatment.  By  so 
acting  you  can  anticipate  injurious  and  prejudicial  reports  and 
suppress  or  shape  them  before  they  become  widely  circulated. 

On  eagle's  wings,  scandals  fly. 

Bear  in  mind  that  such  deaths  are  often  due  to  gross  im- 
prudence of  patient  or  friends,  or  to  some  mischievous  article 
of  food  or  drink  that  has  been  smuggled  in. 

Dropping  in  for  the  purpose  of  preparing  and  giving  to  the 
family  the  certificate  of  death  affords  a  good  chance  for  a  de- 
sired interview  after  any  one's  decease. 

AVhen  you  are  called  to  a  case  of  sudden  death  the  greatest 
composure  of  mind  and  manner  is  essential  and  important;  be 
guarded  and  discreetly  reserved, — 

"  The  tongue  is  the  rudder  of  our  ships," — 

and  never  assume  an  oracular  or  prophetic  air,  or  express  any 
opinion  of  the  cause  in  any  such  case,  but  show  a  Sphynx-like 
determination  neither  to  form  nor  deliver  one,  until  you  have 
carefully  collected  and  duly  considered  all  the  circumstances. 

"  Second  thoughts  are  best." 

The  possibility  of  death  being  due  to  embolism,  or  paralysis  of 
the  heart,  syncope,  pulmonary  apoplexy,  or  other  disease  of  the 
heart,  or  lungs,  or  brain  ;  to  poison,  violence,  or  suicide ;  should 
be  calmly  and  thoughtfully  weighed  before  you  express  any 
opinion ;  for,  should  you  rush  in  with  a  flurry,  neglect  this 
precaution,  and  un-call-back-ably  christen  the  disease  according 
to  your  first-born  opinion,  further  developments  in  the  case  may 
prove  it  to  be  some  other  well-known  affection,  and  expose  you 
either  as  a  butt  to  pleasantry  and  ridicule,  or  to  severe  censure 
and  deep  mortification. 

If  you  are  called  to  a  case  of  sudden  death  in  which  violence 


326  THE    PHYSICIAN    HIMSELF.* 

is  suspected,  or  to  which  you  are  summoned  by  the  police  or 
coroner,  be  very  careful  to  note  everything  in  connection  with 
the  body  and  its  surroundings,  and  also  where  a  post-mortem  is 
necessary,  the  condition  of  the  viscera,  each  one  of  which  should 
be  carefully  examined  before  giving  an  opinion  as  to  the  cause 
of  death.  Your  notes  should  be  taken  by  yourself  or  an  assist- 
ant at  the  time,  in  non-technical  language,  recording  first  the 
year,  day  of  the  month,  and  the  hour,  then  the  facts  of  the  case  and 
your  interpretation  thereof,  and  subsequently  your  comments. 
These  notes  should  be  preserved ;  as  you  will  be  allowed  to 
peruse  them  in  court,  if  summoned  there  to  give  evidence,  in 
order  to  refresh  your  memory ;  though  not  wholly  to  rely  on 
them.  If  the  cause  is  suspected  to  be  poison,  be  very  careful  to 
tie  the  stomach  at  both  ends  before  its  removal,  and  keep  it  and 
its  contents  in  clean,  sealed  vessels,  under  your  own  eye  and 
custody,  till  a  chemical  analysis  can  be  made,  unless  their  care 
be  confided  to  the  police.  If  a  person  be  dying  from  the  effects 
of  violence  (wounds  or  poison),  when  called  to  him,  calmly  and 
feelingly  impart  the  fact  to  him,  and  if  he  volunteer  a  state- 
ment of  the  circumstances  causing  his  injuries,  or  in  reference 
to  his  assailants,  take  his  words  down  at  once  in  his  exact 
language,  as  such  a  statement  will  be  received  in  court  as  if 
made  under  oath,  provided  the  person  makes  it  under  the  belief 
that  he  is  about  to  die  of  his  injuries. 

The  mottled,  reddish,  or  livid  patches,  and  the  purplish- 
black  discolorations  which  appear  on  bodies  shortly  after  death 
occasion  no  little  talk  and  exaggeration  among  the  laity,  and 
are  often  cited  as  evidence  of  the  malignant  or  putrefactive 
nature  of  the  death  sickness,  or  as  proof  of  ante-mortem  vio- 
lence, while  they  are  really  due  to  post-mortem  contraction  of 
the  walls  of  the  arteries,  which  squeeze  the  greater  part  of  their 
blood  into  the  veins ;  through  whose  flaccid  coats  a  portion  of 
its  separated  coloring  matter  escapes  into  the  surrounding  tis- 
sues, creating  the  appearance  mentioned.  The  escaped  flnid 
tends  gradually  to  collect,  by  the  law  of  gravity  in  the  most 


HIS   REPUTATION    AND    SUCCESS.  327 

dependent  parts  of  the  body,  as  the  back  of  the  neck,  trunk, 
and  Hmbs,  thus  leaving  the  higher  parts  clear  and  wax-like  in 
appearance. 

You  can  always  distinguish  these  post-mortem  appearances 
from  bruises  inflicted  during  life  by  making  an  incision  into 
them.  If  post-mortem,  you  will  find  the  blood-stain  superficial 
and  not  involving  the  tissues  beneath,  but  the  contrary  if  due  to 
violence  during  life.  In  the  latter  case,  moreover,  they  cannot 
be  removed  by  pressure  or  change  in  the  position  of  the  body. 

The  popular  belief  is  that  if  a  sudden  death  begins  at  the 
heart  there  must  have  been  a  pre-existing  disease  of  the  heart, 
and  the  family  physician  is  often  reproached  for  not  having  dis- 
covered it  during  the  patient's  life-time.  You  will  do  well  to 
explain  that  the  healthiest  heart  may  suddenly  become  para- 
lyzed or  mechanically  occluded  (thrombosis  or  embolism)  and 
sudden  death  result.  Bear  in  mind,  also,  that  the  ordinary 
termination  of  organic  heart  disease  is  not  sudden,  but  verv 
slow,  death,  preceded  by  dropsy,  inability  to  lie  down,  etc. ;  in 
fact,  with  the  exception  of  cases  of  aortic  stenosis,  or  regur- 
gitation, or  fatty  degeneration,  there  are  few,  if  any,  forms  of 
organic  heart  disease  that  cause  sudden  death.  Of  course, 
syncope,  from  mental  emotion  or  physical  exhaustion,  if  not 
promptly  and  properly  met,  may  cause  sudden  death,  even 
when  the  heart  is  entirely  free  from  disease. 

A  belief  that  stout,  healthy  people  endure  accidents,  opera- 
tions, accouchements,  diseases,  etc.,  better  than  weaker,  com- 
plaining people  is  another  popular  error.  The  truth  is  tlie 
latter  are  scliooled  to  pain,  to  disordered  functions,  lack  of  exer- 
cise, etc.,  and  when  they  have  to  endure  afflictions,  the  mutation 
from  their  ordinary  condition  is  less  than  in  the  former,  and 
they  have  not  so  much  vital  force  to  be  perverted  into  morbid 
action,  and  in  many  instances  their  cases  turn  out  more  satisfac- 
torily. Plethoric  systems  generally,  strange  as  it  may  seem,  bear 
depletion  by  blood-letting,  purgation,  etc.,  badly,  because  their 
circulation  is  accustomed  to  a  certain  degree  of  fullness  and  ten- 


328  THE    PHYSICIAN    HIMSELF: 

sion,  anything  short  of  which  causes  disturbance  of  the  different 
functions.  The  loss  of  a  few  ounces  of  blood  will  sometimes 
cause  a  plethoric  man  to  faint,  while  a  spare  one  might  have 
lost  a  like  or  larger  quantity  without  injurious  effect. 

Old  persons  seldom  bear  surgical  operations  well,  especially 
if  they  have  any  disease  of  the  urinary  organs.  Make  it  a  rule, 
therefore,  always  to  examine  their  urine  before  operating.  If 
any  such  patients  die  from  shock,  narcosis,  haemorrhage,  or 
sepsis,  after  your  steel-edged  interference  with  harmless  growths; 
or  deformities,  or  ailments  which  they  have  endured  for  years 
with  only  a  certain  amount  of  inconvenience,  you  will,  in  all 
probability,  be  greatly  blamed,  and  accused  of  having  operated 
simply  for  the  expected  fee,  or  to  show  applauding  by-standers 
your  energy,  your  dazzling  skill,  or  your  manual  dexterity. 

You  are  not  expected  to  set  aside  the  laws  of  nature,  and 
will  seldom  be  censured  for  a  fatal  issue  in  the  diseases  of  the 
ao-ed,  and  never  in  those  of  hard  drinkers,  or  in  cases  in  which 
you  have  given  an  unfavorable  prognosis  from  the  first.  On  the 
other  hand,  if  a  woman  dies  in  her  confinement  you  will  be 
cuss'd  and  discussed,  and  if  there  is  any  possible  chance  to 
blame  you  it  will  be  done,  for  the  reason  that  parturition  is 
rightly  regarded  as  totally  dissimilar  to  disease.  Child-bearing 
is  designed  by  nature  to  increase  and  not  to  diminish  the  number 
of  our  race ;  death,  therefore,  in  labor,  which  is  a  physiological 
function,  or  during  the  lying-in,  which  is  a  physiological  state, 
seems  contrary  to  nature,  and  produces  a  shock,  and  often  evokes 
severe  criticism. 

Wretched,  heart-broken  patients  who  are  suffering  acutely, 
perhaps  afflicted  with  painful,  incurable  diseases,  and  the  miser- 
able, flabby  melancholiacs,  with  all  their  emotional  chords  out 
of  tune,  who  are  a  hopeless  burden  to  themselves  and  to  others, 
will  occasionally  imploringly  ask, 

"Is  there  no  short,  no  gentler  way 
To  mingle  with  our  fellow-clay?" 

and  prayerfully  plead  to  you  from  the  depths  of  earnestness  to 


HIS    REPUTATION    AND    SUCCESS.  329 

give  them  something  to  put  them  out  of  the  (to  them)  weary, 
weary,  weary  world.  Likewise,  in  the  case  of  those  who  are 
enduring  terrible  sufferings  from  which  recovery  is  impossible, 
or  at  the  birth  of  deformed  and  monster  infants,  or  with  helpless 
imbeciles,  the  friends  will  also  sometimes  hint  at,  or  even  openly 
request,  that  a  sleeping  potion  may  be  given  with  the  view  to 
release  the  unfortunates — by  death. 

"  It  were  an  alms  to  hang  him." 

In  many  such  cases  you  will  agree  with  the  view  that — 
were  God  to  take  the  poor  sufferer  it  would  be  a  blessing ;  yet 
with  this  aspect  of  the  case  you  have  nothing  to  do.  In  re- 
fusing such  solicitations,  in  sympathetic  but  explicit  language, 
let  your  argument  be  that  human  life  is  sacred,  and  that  no  man 
has  a  right  to  say  another's  life  is  useless,  or  with  Nero, — 

"Twenty  more  with  no  excuse  for  living  !     Kill  them,  too," — 

and,  also,  that  since  a  person  has  no  right  to  end  his  own  exist- 
ence, he  cannot  delegate  such  a  right  to  another,  and,  even  if 
he  could,  you  would  be  the  wrong  person  to  ask,  since  your 
province,  as  a  physician,  in  the  great  drama  of  life  is  to  prolong 
life,  not  to  shorten  it. 

So  sacred  is  human  life  that  were  you  to  perform  craniotomy 
and  the  child  be  still  alive  when  born,  or  should  you  deliver  a 
monster  unfit  for  earth,  you  have  no  right  to  extinguish  life  in 
either.  You  may,  occasionally,  actually  be  blamed  for  saving  a 
life  that  selfish  guardians  don't  want  saved, — whom  they  want 
out  of  the  way. 

Many  cases  admit  but  gradually  of  a  diagnosis  and  prog- 
nosis. In  accidents  obscive  as  to  nature  or  degree,  and  in  cases 
of  sudden  illness,  when  you  are  pressed  to  say  whether  you 
consider  the  case  dangerous,  or  likely  to  be  of  long  duration, 
reply  deliberately  and  avoid  giving  definite  answers,  until  you 
see  whether  any  graver  affection  is  hidden  behind  the  present 
symptoms,  whether  new  symptoms  will  develop,  whether  the 
system  will  react,  and  whether  there  will  be  a  response  to  the 


330  THE    PHYSICIAN    HIMSELF  I 

remedies  used.  During  the  progress  of  such  cases  be  careful  to 
school  your  features  and  your  manner,  so  that  people  may  be 
unable  to  read  your  hesitations,  doubts,  and  surprises, — 

Like  the  pages  of  a  printed  book, — 

and  either  insist  on  consultations  or,  maybe,  dispense  with  your 
services.  Therefore,  in  giving  a  diagnosis  or  prognosis,  you 
should  always  use  the  plainest  (English)  language  and  as  con- 
cisely as  possible,  and,  whenever  and  wherever  it  is  necessary  to 
repeat  it,  it  is  best  to  adhere  as  closely  as  possible  to  the  same 
phraseology. 

In  cases  of  accident  and  injury  to  people  found  in  an  in- 
sensible condition  on  the  highways,  or  lying  in  bar-rooms  or 
at  station-houses,  life  itself  may  depend  wholly  on  a  proper 
diagnosis ;  therefore,  although  you  may  strongly  suspect  them 
to  be  due  to  drunkenness,  you  will  act  wisely  to  do  no  guessing, 
but  give  a  provisional  opinion  only,  until  they  return  to  a  sober 
state.  It  is  better  to  say,  "  He  is  unconscious ;  whether  his 
insensibility  be  due  to  alcohol,  or  to  other  causes  affecting  the 
brain,  it  is  at  this  time  impossible  for  any  one  to  say." 

Never  pronounce  that  an  injured  limb  is  "  only  bruised  or 
sprained,"  and  order  liniment,  with  assurances  that  it  will  be 
all  right  in  a  few  days,  until  you  are  positive  that  it  is  not  frac- 
tured or  dislocated ;  or  the  continued  pain  and  swelling  may 
carry  the  patient  to  some  more  cautious  physician,  who  will  dis- 
cover the  truth,  to  his  great  honor  and  your  great  shame.  A 
great  many  of  your  brethren  have  been  caught  in  this  trap. 

Bear  in  mind  that  death  following  an  injury  does  not 
always  mean  that  it  resulted  from  the  injury. 

"Death  has  a  thousand  doors  to  let  life  out." 

It  is  well  when  called  to  cases  of  serious  burns,  cuts,  lacer- 
ations, fractures,  bites,  etc.,  to  mention  incidentally  to  the  family 
the  possibility  of  the  supervention  of  erysipelas,  septicaemia, 
lock-jaw,  etc.,  and  of  deformity,  or  permanent  impairment,  or 
whatever  other  unpleasant  results  may  be  reasonably  feared,  so 


HIS    REPUTATION    AND    SUCCESS.  331 

that  the  parties  may  know  that  you  are  ahve  to  all  the  possibil- 
ities and  probabilities  of  the  case.  With  regard  to  burns,  remem- 
ber that  the  gravity  of  a  burn  is  often  due  less  to  its  depth  than 
to  the  extent  of  surface  involved. 

In  the  course  of  your  professional  career  you  will  come  into 
contact  with  humanity  in  all  its  varied  aspects  and  phases,  and 
your  patients  will  greatly  differ  in  the  nature  and  extent  of 
complaint  which  they  will  make  in  detailing  their  subjective 
symptoms  to  you.  Some  who  are  naturally  stoical  and  apa- 
thetic will  fall  into  the  error  of  imderstating  their  true  condi- 
tion, fearing  that  a  fuller  statement  may  alarm  their  friends,  or 
lead  you  to  think  their  case  serious,  and  to  prescribe  much  and 
strong  medicine  for  them,  or  induce  you  to  pay  them  manv 
visits.  Such  patients  will  sometimes  die  almost  without  giving 
a  sign.  Others,  again,  of  a  hysterical  or  nervous  temperament, 
fearing  that  you  may  not  consider  them  as  ill  as  they  really  are, 
or  as  they  conceive  themselves  to  be,  will,  in  detailing  their 
symptoms,  magnify  every  detail,  and  seek  in  every  way  to  im- 
press you  and  others  with  an  exaggerated  idea  of  the  intensity 
of  their  sufferings  and  the  gravity  of  their  condition.  One  of 
the  many  advantages  which  one's  regular  attendant  has  over 
other  physicians  is  his  familiarity  with  these  peculiarities  of 
temperament,  with  the  extent  of  the  vocabulary  that  each  of 
his  patients  employs,  and  with  the  amount  of  precision  which 
each  uses  in  answering  questions  and  in  describing  his  sufferings. 
A  gilt-edged  society  lady,  a  hod-carrier,  a  lawyer,  a  backwoods- 
man, a  school-miss,  a  straight-laced  old  maid,  a  sailor,  and  a 
girlish  dude  would  each  use  a  different  kind  of  language  to 
express  the  same  symptoms. 

In  spite  of  your  earnest  and  best  endeavors,  you  will  often 
be  criticised  or  upbraided  for  your  lack  of  foresight  in  relation 
to  the  recovery  or  death  of  patients.  The  ability  to  estimate  the 
vital  resistance  in  each  case,  by  the  temperature,  pulse,  look, 
visage,  voice,  attitude,  movements,  and  general  appearance  of 
the  patient,  is  essential  to  the  perfection  of  your  skill  as  a  phy- 


332  THE    PHYSICIAN    HIMSELF: 

sician.  It  is  something  apart  from  your  diagnosis,  pathological 
and  therapeutical,  and  few  attain  it. 

The  truth  is  that  life  is  a  different  quantity  in  different 
people :  one  man  will  scratch  his  finger  with  a  pin  and  die, 
another  will  get  both  legs  cut  off  and  live,  and  you  will  usually 
have  no  other  way  to  judge  this  or  that  patient's  prospect  of 
recovery  from  either  of  the  twenty-four  hundred  different  mala- 
dies that  afflict  mankind  than  by  the  average  human  standard. 
You  will  sometimes  have  cases  which  will  baffle  every  method 
of  calculation  and  surprise  you  by  their  possessing  a  great  deal 
7e5s,  and  others  by  having  a  great  deal  more^  than  the  average 
tenacity  of  life ;  and,  no  matter  how  careful  you  are,  there  exist 
rocks  that  are  not  to  be  climbed,  and  pits  not  to  be  fathomed, 
and  things  which  are,  from  their  very  nature,  unknowable ; 
hence,  you  cannot,  with  our  present  knowledge,  accurately  and 
unfailingly  prognosticate  the  endurance  power  of  every  patient. 

To  illustrate  what  is  meant : — 

Health, 0. 

1st. 

2d. 

3d. 
Classes, {  4:th. 

5th. 

6th. 

7th. 

Suppose  the  above  seven  figures  to  represent  the  various 
degrees  of  mankind's  ability  to  endure  sickness  and  injury,  and 
that  the  fourth  figure  represents  the  average  extent  of  human 
endurance  power :  some  patients,  then,  will  actually  succumb 
and  die  like  sheep  if  the  first  degree  be  passed,  some  if  the 
second  be  reached,  others  can  endure  to  the  third,  and  so  on, 
while  still  others,  with  iron  constitutions",  have  tenacity  of  life 
enough  to  recover  after  going  as  low  as  the  fifth,  or  even  the 
sixth  degree.     Now,  if  you  could  penetrate  each  patient's  vital 


HIS    REPUTATION    AND    SUCCESS.  333 

recesses  and  measure,  as  with  the  rule  and  the  compass,  his 
assimilation  and  innervation,  absorption  'and  secretion,  repro- 
duction and  decay,  sensation,  motion,  and  reflex  action,  and  the 
total  of  Ms  endurance  power, — could  see  at  what  point  his  pos- 
sibility of  recovery  ends  and  his  dissolution  begins, — you  could 
disentangle  and  unroll  the  concatenated  web  of  life  from  perfect 
health  to  death,  solve  the  great  problem,  and  make  the  strength 
of  this  web  a  matter  of  mathematical  certainty.  There  would 
then  be  fewer  unanswerable  hows  and  whys,  and  you  would 
seldom,  if  ever,  be  reproached  for  unpredicted  terminations. 
This  neither  you  nor  any  other  mortal  can  do ;  but  you  can 
prepare  yourself  on  all  points,  and  make  anatomy  and  physiol- 
ogy your  grammar  and  dictionary,  and  pathology  your  crown- 
ing study  ;  also,  keep  your  eyes  and  ears,  mind,  heart,  genius, 
and  talent,  all  wide  open,  and  make  use  of  the  teachings  of 
accumulated  experience,  and  avail  yourself  fully  of  every  aid 
oftered  to  you  by  advancing  medical  science. 

Full  many  a  pupil  has  become 
More  famous  than  his  master. 

Disease  and  pain  and  death  are  parts  of  the  plan  of  crea- 
tion. Disease  is  ever  afflicting  thousands  of  earth's  children  in 
every  clime,  while  death  (on  his  pale  horse)  is  busy  from  pole 
to  pole.  Fear  of  the  former  and  dread  of  the  latter  are  parts 
of  human  nature,  and  these  (fear  and  dread)  cause  mankind 
everywhere  to  employ  physicians :  the  prince  in  his  palace,  the 
peasant  in  his  cottage,  and  the  outcast  in  his  hovel ;  the  citizen 
in  his  mansion,  the  laborer  in  his  shanty,  and  the  felon  in  his 
dungeon ;  the  millionaire  and  the  beggar ;  the  conqueror  and 
the  captive ;  the  lord  and  the  serf ;  the  sailor  and  the  soldier ; 
the  purple  of  authority,  the  ermine  of  rank,  and  the  rags  of 
squalor ;  the  man  of  religion,  the  man  of  law,  and  the  man  of 
science  ;  every  nation  and  tongue,  the  Christian,  the  Jew,  and 
the  Pagan ;  the  pale-faced  Caucasian,  the  Hindoo,  the  painted 
Feejee,  the  oily  and  savage  Hottentot  on  the  burning  plains 
of  Africa ;  the  tattooed,  fierce,  brutal  New  Zealander,  and  the 


334  THE    PHYSICIAN    HIMSELF: 

sinewy  savage  of  our  own  far  west ;  the  Esquimau  in  tlie  blood- 
chilling  Arctic  regions,  and  humanity  in  the  pestilential  swamps 
and  jungles  of  the  tropics ;  wherever  sick  and  suffering  man- 
kind is,  they  turn  to  our  guild  for  relief. 

This  reliance  of  humanity  on  you  as  a  physician  skilled 
to  heal  its  wounds  and  to  cure  its  diseases  naturally  brings 
you  in  contact,  on  one  side,  with  mankind's  greatest,  most  vital 
interests,  and,  on  the  other,  with  the  great  science  and  glorious 
art  of  medicine,  and  makes  your  power  in  your  legitimate  sphere 
almost  monarchial.  You  go  when  you  please  and  come  when 
you  will,  order  what  you  choose  and  forbid  what  you  may. 
You  are  intrusted  with  secrets  that  would  be  confided  to  no 
other  person,  and  -are  as  an  honorary  member  and  guardian  to 
every  family  you  attend ;  and  you  wield  strong  influence  over 
husbands,  wives,  children,  and  servants,  and  lay  down  laws  to 
govern  each  in  matters  of  life  and  death,  and  are  obeyed  almost 
as  implicitly  as  though  you  were  Julius  Csesar  or  the  Czar  of 
Russia, — 

"The  foremost  man  in  all  this  world," — 

and  your  knowledge,  skill,  and  attention  will  be  many  and 
many  a  one's  last  earthly  hope. 

Thus,  you  see,  no  other  men  under  heaven  can  do  as  much 
good  as  physicians  !  Others  may  have  the  will,  but  they  have 
not  the  power  and  opportunity  ;  this,  with  its  humane  nature, 
makes  ours  as  noble  a  calling  as  exists  on  the  face  of  the  earth, 
— a  calling  capable  of  developing  all  the  good  qualities  of  one's 
heart,  hand,  and  brain. 

Bear,  therefore,  the  greatness  of  your  trust  and  the  respon- 
sibility and  glory  and  almost  divine  mission  of  our  sublime  and 
ennobling  profession  ever  in  mind,  and  remember  at  all  times 
that  every  action,  every  phase  of  your  conduct,  every  word  you 
utter,  every  look,  every  nod  of  your  head,  tremble  of  your 
tongue,  quiver  of  your  lips,  wink  of  your  eye,  and  shrug  of 
your  shoulders,  will  be  observed  and  weighed.  Therefore,  strive 
to  make   your  character  and  your  methods  as  faultless  as  pos- 


HIS   KEPUTATION    AND    SUCCESS.  335 

sible,  and  let  no  word  ever  escape  you  unsuitable  to  the  occasion. 
Also  keep  your  lamps  trimmed  and  your  oil  ready,  and  observe 
punctuality  and  system  in  attending  all  who  place  themselves 
under  your  care,  and  strive  to  do  the  greatest  absolute  good  for 
each  and  every  one  who  trusts  to  your  skill  for  relief,  that  you 
may  fill  every  bosom  with  kindness  toward  you,  and  every 
mouth  with  praise ;  and  be  truly  called  A  Good  Physician. 


Thus,  my  professional  brothers,  I  would  attempt  to  show 
that  the  more  closely  we  study  the  moral  and  physical  peculi- 
arities of  the  various  classes  that  make  up  the  community,  the 
more  clearly  we  will  see  that  the  practice  of  medicine  has  a 
peculiar  and  complex  environment,  and  that  We  should  make 
skill  in  preventing,  relieving,  and  curing  disease  our  cen- 
tral thought  and  our  chief  reliance,  and,  as  men  and 
brothers.  should  discharge  each  and  every  duty  to  our 
Great  Master's  entire  family,  at  all  times  and  in  all 
PLACES,  WITH  fidelity  AND  HONOR;  and,  further,  that  we  must 
also  possess  professional  tact  and  business  sagacity  if  we  would 
succeed  in  the  profession  to  the  fullest  extent  that  lies  in  us, 
and  create  for  ourselves  corresponding  spheres  of  usefulness  in 
the  world. 


In    CONCLUSION,  I  FONDLY  HOPE   THAT   THIS   LITTLE   BoOK  ON 

The  Physician  Himself  may  teach  those  who  follow  its 
suggestions  to  surmount  the  many  obstacles  and  decide 
the  many  dilemmas  that  arise  in  the  course  of  profes- 
sional life  ;  and  also  aid  them  to  discern  the  straight  and 
noble  path  more  clearly;  and  to  follow  it  more  bravely, 
more  faithfully,  and  more  successfully;  for  the  book 
that  does  these  will  be  of  unspeakable  benefit,  and  will 
live  to  serve  the   profession  for  many,  many  years;    and 

neither   chisel  nor  hand of  bronze,  marble,  or   gold 

could  build  its  author  a  better  or  more  enduring  monument. 

D.  W.  C. 


INDEX. 


A.billty,  popular  tests  of  professional,  88 
Abortifacients,  prescribing  pretended,  78 
Abortion,  solicitations  to  produce,  77,  78, 

79 
Accidents,  demeanor  in  attending,  174, 

324,  330 
Accounts,  necessity  for  keeping,  18 
Adding  suffixes,  91 
Advertising,  why  unethical,  104 
Advice,  giving,  relating  to  health,  129, 

198.  199 
^sculapius  and  Hygeia,  symbols  of,  140 
Aged,  operations  on  the,  328 
Ailments  not  to  be  ridiculed,  124 
Allopathy,   a  misnomer,-  245,    249,  250, 

251 
AmenorrhcEa  in  consumptives,  182 
Analyses,  why  make  your,  at  home,  203 
Anaesthetics,  in  trifling  cases,  165 

precautions  regarding,  164 
Are  boils  healthy  ?  188 
Art  of  changing  medicines,  174,  212 
Assistant,  acting  as,  3,  128,  129,  221 
Assistants,  four  excellent,  194 
Attending  another's  practice,    103,   104, 

129 
by  the  year,  292 
Autopsies  on  private  cases,  113 
Avarice,  305 
Avoid,  something  to,  79 

Babes,  hand-fed,  184,  185 
Bandaging  too  tightly,  164 
Baptism,  conditional.  135 
Bargains,  Indian,  111 
Beans,  Panama,  197 
Bills,  17,  280-323 

how  to  present,  303,  304,  315 

special  color  for,  322 
Black  lists,  322 

lilame,  laws  that  govern,  196,  197,  338 
Boasting,  36,  37 
Boils,  are  they  healthy?  188 
Boldness,  51 
Book-agents,  85 
Books,  buying,  85,  86 
Books,  family  medical  guide,  180 

posting  one's,  387,  390 
Bores,  50,  170,  171 
Borrowing,  92 
Bread-pills,  151 
Business  system,  9 

the  proper  time  to  talk,  285,  301 
Busy,  too,  171,  302 


Calls,  hurried,  20 

list  of,  to  prepare,  288 
Cards,  business,  17 
Carriages  and  horses,  26,  27,  28 
Case,  withdrawing  from  a,  155 
Cases,  refusal  to  take,  115,  117,  171 

why  never  abandon,  139,  160 
Cash  system,  the,  283 
Catholic  patients,  duty  to,  117-137 
Cautions,  21,  325,  380 
Censure,  the  laws  of,  328 
Certificates,  death  and  other,  75, 125,  269, 
270,  271 

clergymen's,  270,  271 

legal,  125 
Changing  diagnosis  and  prognosis,  121 

medicines,  art  of,  174,  212 
Chapters,   beginning  of,  1,  35,   77,   106, 
131,  163,    193,  208,  227,   259,  280. 
324 
Charges,  increasing  one's,  293 
Charities,  special,  310,  311,  312 
Charity,  the  demands  of,    57,  101,    309, 

310 
Cheap  doctors,  295 
Cheerfulness  in  the  physician,  48 
Children,  crossness  and  tears  in,  186 
Children's  influence.  54,  99 
Chloral  and  other  hypnotics,  157,  206 
Chronic  discharges,  suppressing,  145, 188 

diseases,  patients  with,  138,  145 
Clandestine  visits,  131,  142 
Clergymen,    ministrations  of,  131,    237, 

238,  270,  271 
Coincidences,  good  and  bad,  165 
Coition,  why  not  recommend,  181 
Cold  rooms  in  sickness,  184 
Collecting  bills,  280,  323 
Collector,  321 

Commission  versus  omission,  162 
Commodes  in  bedrooms,  187 
Companions,  what  kind  to  select,  10,  11 
Competition,  wars  of,  291,  292 
Concealing  presence  of  disease,  126,  127 
Conditional  baptism.  135 
Conduct  in  the  sick-room,  46-56 
Confidants,  120,  122 
Confidence,  the,  of  patients,  50 
Confinement,  purgative  after,  191 
Confinements,  attending  women  in,  114- 

117  ^ 

Congestion,  hypostatic,  114,  326,  327 
Consult,  right  of  refusal  to,  214,  215 
Consultation  fees,  212,  213 

'  (337) 


338 


INDEX. 


Cousultation,  punctuality  in  attending, 
211 
radical  changes  after,  213 
room,  arraugemeat  of,  6,  7,  8 
the  suspense  preceding  a,  211 
whom  to  call  into,  211 
Consultations,  management  of,  121,  220 

object  of,  210,  220 
Consulting  physician,  dispensing  with, 

214 
Consumption,  errors  regarding,  182,  183 
Consumptives,  why  they  cease  to  men- 
struate, 182 
Contagion,  fear  of.  190 
Contagious  disease,  cautions  regarding 

attendance  upon,  126,  127 
Contingent  fee,  why  not  work  for,  293 
Contracts  to  do,  what  a  physician,  70, 

72,  171 
Costly  medicines,  274 
Countenance,  the  physician's,  174,  324, 

325,  330 
Creaking  boots,  92 

Creed,  difference  between  limiting  one's, 
and  limiting  one's  practice,  229, 
230 
Critics  and  wiseacres,  172,  173 
Cuckoo,  the,  32 
Cures,  guaranteeing,  124,  298 

Dampness,  191 

Death,  appearances  after,  326 

causes  of  sudden,  178,  327 
Death,  the  power  of,  132,  139,  140 
Debates,  how  to  conduct,  83,  84 
Decrying  medicine,  221-225 
Degree   of  certainty  in   medicine,   221, 

222,  227,  332 
Dialogues,  112,  264 
Dictionaries  and  encyclopaedias,  37 
Diet-list,  200 
Dining  out,  96 

Discharges,  suppressing  chronic,  188 
Discoveries,    attitude  of  physicians   to- 
ward, 230 
Discussions,  joint,  232 
Diseases,  chronic,  138 

driving  in,  188 

fees     in     advance      for     attending 
secret,  117,  299,  300,  301 

number  of  mankind's,  332 

the  increased  tolerance  of,    225,  226 

urinary,  179,  328 

venereal,  118,  300,  301 
Dishonesty,  where  found,  312,  313,  314 
Dismissal  of  medical  attendants,  67,  68, 

155,  156 
Dispensarj^  and  hospital  patients  com- 
pared with  private,  60 
Dispensaries,  free,  310,  311,  312 
Doctor,  bestowing  the  title  of,  236 

or  physician,  14 


Doctoring  the  womb,  176 

Dog-bites,  189 

Donations,  making,  101 

Dosao;e,  rules  for,  149 

Doses,  heroic,  149,  152,  156 

Double  callings,  23,  24.  25 

Dress  and  manners,  influence  of,  21,  22, 

23 
Dressing  too  warmly,  183,  184,  185 
Drinking,  11,  93,  94 
Druggists,  259-279 
Drugs,  etc.,  got  gratis,  261 

necessity  for  pure,  275,  276 

that  enslave,  206 
Duties,  five  cardinal,  157 
Duty  to  the  dying,  131-138 
Duty  to  the  laws,  125,  148 

Eat  anything,  may  he?  200 

Eating  with  patients,  96 

Education,  its  importance  to   the  phy- 
sician, 38,  39 

EiTiergency  cases,  20,  67,  122 

Engagements,  making,  60,  70 

Enmity,  personal,  35,  36,  94 

Entansilements,  to  avoid,  166,  167 

Epidemics,  126,  127 

Error,  precautions  to  take  against  com- 
mitting, 78,  157,  158 

Eruption,  driving  in,  188 

Eruptions,  bringing  out,  188 

Estate  of  deceased  physician,  818,  319, 
320 

Estates,  charges  against,  307 

Ethics,  medical,  60-70 

Eucharist,  the  Holy,  135 

Examinations,  careless.  158 

gentleness  in  making,  54,  55 

Examining  boards,  235 

Expedients,  doubtful,  66 

Experience,  value  of,  107,  108,  109 

Experiments  tried  on  patients,  159 

Experts,  pseudo-medical,  73,  74 

Exposing  false  systems,  233 

Extreme  Unction,  134 

Extremists,  238 

Fainting,  189 

Familiarity,  undue,  10,  96,  141,  144 

Family,  a'physician  attending  his  own, 

302 
Fashionable  frauds,  312,  313 
Fashion  in  medicine,  152 
Fashion  and  wealth,  influence  of,  236 
Fashions,  conforming  to  the,  22 
Fear  of  contagion,  190 
Fee  in  advance  for  secret  diseases,  299, 
300 

or  no  fee,  298 

table,  18,  291,  309 
Fees,  245-323 

doubtful,  rule  regarding,  283,  284 


INDEX. 


339 


Fees,  fixincr  the  responsibility  for,  285 

for  important  cases,  295,  296,  297 

how  to  collect,  301,  302,  303,  314,  315 

joint,  308 

lawsuits  to  recover,  306 

office,  18,  19 

why  not  work  for  contingent,  298, 
299 
Female,  examining  a,  against  her  will, 

165 
Females,  influence  of,  12,  98 
Feuds,  professional,  35 
Fever,  water  and  ice  in,  200 
Fickleness,  human,  130,  153-156 
Finances,  the  physician's,  317,  321 
Fingers,  the  tips  of  a  physician's,  93 
Foreign  bodies,  swallowing,  189 
Forgot  you,  I,  117 
Formulae,  private  use  of,  261 

stereotyped,  43 
Fractures,  popular  error  regarding,  165 
Frauds,  f\ishionable,  312,  313 
Free  dispensaries,  310,  311,  312 
Friends,  making,  47,  48,  49 

German  language,  usefulness  of  the,  41 

Golden  rule,  the,  36,  62 

Gratifying  whims,  168 

Greek  language,  usefulness  of,  40 

Guaranteeing  cures,  124,  298 

Guard  yourself,  151 

Guides  in  judging  whether  a  pharmacy 

is  properly  conducted,  268,  274 
Gums,  object  of  lancing  children's,  185, 

186 

Habits,  disgusting,  9-10,  92,  93,  96 

professional,  31,  32.  33 
Hahnemann  compared  with  Copernicus, 

Newton,  and  Jenner,  247 
Hand-fed  babes,  184,  185 
Health,  how  to  maintain  your,  21,  101, 

102,  103 
trips  for,  198,  199 
Heart  disease,  death  from,  327 
Hectic  confounded  with  malarial  fever, 

ICO 

Hell  on  earth.  175 

Heroic  doses,  149,  152,  156 

High  science,  87,  88 

Holy  Eucharist,  the,  135 

Home,  not  at,  171 

Homoeopathic  creed,  the,  244,  245 

Homoeopaths,  bogus,  254,  255 

test  showing  which  are  real,  258 
Homoeopathy,  243-258 

is  it   founded  on   the   sole   natural 
law?  247,  248 

one  of  the  evils  of,  251,  252 
HomcBO  versus  liome,  252,  253 
Hope,  50 

taking  away,  50,  139 


Horrifying  remedies,  195 
Horses  and  carriages,  26,  27,  28 
Hospital  and  dispensary  patients   com- 
pared with  private,  60,  61 
Hospitals,  sending  patients  to,  199 
Hours,  designating  the,  on  bottles,  206 
How  to  conduct  debates,  83 
Human  fickleness,  130,  153-156 

gullibility,  231 

life,  value  of,  55 

nature  the  same  everywhere,  327 
Humanity,  its   demands,"  216,  217,  253, 

309 
Humoring  the  sick,  50,  168 
Hurried  calls,  20 
Hydrophobia,  189,  190 
Hypodermatic  medication,  206,  207 
Hypostatic  congestion,  114,  326 

Idiosyncrasy,  58,  241 

I  forgot  you  !  117 

Important  cases,  fees  for  attending,  287, 
294-297 

Incompatibles,  42 

Indian  bargains,  116 

Indorsing  domestic  remedies,  169 

Infants,  having  physicians  for  sick,  187 

Influence  of  dress  and  manners,  21,  22, 
23 
of  females,  12,  98 

Ink,  best  color  to  use,  289 

Inquiries,  making,  etc.,  in  presence  of 
strangers,  119 

Instruments  of  precision,  20,  178 

Insults,  121 

Interest,  evincing,  in  cases,  56,  57 

Iron  injuring  the  teeth,  196 

Irregular  pliysicians,   contact  with,   10, 
215,  255 
what  constitutes,  215,  217 

Irregulars,  joint  discussions  with,  232 
popular  favor  toward,  235,  236 
proper  course  toward,  10,  215,  254 
why  patronized,  235-239,  252 

Jealousy,  30,  31,  32,  35,  120,  167 
Jenner,  256 
Joint  fees,  308 

discussions,  232 

practice  of  medicine  and  pharmacy, 
259,  311 
Junior,  posing  as  a.  111,  112 

Kindness,  influence  of,  50,  57 

Labeling,  mistakes  in,  278 

prescriptions,  195,  205,  277,  278 

Labels,  advantage  of  putting  the   date 
on,  278 
putting  the  hours  on,  206 

Languages,  learning  foreign,  41 

Latin,  use  of,  38,  39.  40 


uo 


INDEX. 


Laws,  duty  to,  125,  148 

favor  shown  to  physicians  by  the, 

125,  126 
medical,  233,  234,  235 
their  exceptional  kindness   to  phy- 
sicians, 105 
Lawsuits,  72,  73,  306 
Ledger,  why  keep  a,  18 
Legal  duty  to  patients,  70,  72,  171 
Liberal  profession,  wliy  medicine  is   a, 

219 
Library,  contents  of  one's,  85,  86 

creating  a,  85,  86 
Life-insurance,  72 
for  self,  320 
power  of  human   endurance,  scale 

of,  332 
should   a   physician    ever  shorten? 
328,  329 
Limiting  one's  practice,  117,  229,  230 
List  of  visits,  how  to  prepare  a,  288 
Local  option,  ordering  liquor  under,  95 
Locate,  where  to,  3-6 
Longevity  of  physicians,  319 

Malarial  affections,  recurrence  of,  197 
Malingerers,  60,  124 
Malpractice  cases,  72-75,  162,  163,  164 
suits,  wlxy  there  are  more  surgical 
than  medical,  163 
Mankind,  study  of,  44,  193,  194,  831 
Mankind's   dependence   on   physicians, 

333,  334 

Manners,  influence  of,  37,  47-49,  51-54, 

92,  93,  99 
Marriage  of  physicians,  97 

of  syphilitics,  181 
Marriages,  unlucky,  97,  98 
Maxim,  312 
Medical  profession,  greatness  of  the,  333, 

334,  335 

art,   imperfection  of,   221,   222,   223, 
227 

ethics,  61-70 

examining  boards,  235 

societies,  81-84 
Medicine,  decrying,  221,  222,  223 

degree  of  certainty  in,  221,  222,  223, 
227 

fashion  in,  152,  240,  243 

fear  of  193,  194,  195 

haters,  193 
Medicines,  art  of  changing,  174 

at  office,  19 

bad  effects  of  195 

charges  for,  262.  263,  274 

costly,  suggestions  resrarding,  263 

palatability  of,  193,  194 

the  dynamization  of,  348,  249 

unused,  174 
Memory  of  cases,  85,  145 
Menial'labors,  122 


Mental  therapeutics,  150,  151,  194 

Metric  system,  90 

Microscope,  working  with  the,  114 

Midwives,  assisting,  116 

Milwaukee  physicians,  offer  of  the,  248 

Mineral  versus  vegetable  medicines,  196 

Mischief-makers,  120 

Mistakes  of  pharmacists,  266,  277,  278 

in  compounding,  cases  of,  266 
Moralizing,  129 
Morphia  siranules,  242 
Motto  onlaills,  312 

Name,  what  is  in  a?  249,  250,  251.  253 
Neglectful  and  perverse  patients,  168 
Neighborly  visits,  30 
New  remedies,  how  aided,  194 
Newspaper  squibs,  29,  103,  170 
Night  emissions,  182 

visits,  142 
No  cure,  no  pay.  298 
Nostrums,  why  condemn,  273 
Novelty,  influence'of,  in  medicine,  168 
Number  of  mankind's  diseases,  332 
Nurses,  conduct  toward,  167,  186 

Objects  of  consultations,  210,  220 

Obstetrical  cases,  114-117 

Office,  absence  from,  15 

Oflace,  charges  for  advice  at,  18,  180,  297 

hours,  i6,  17,  18 

location    and   arrangement  of,    5-9 

outfit,  6,  7,  19 

practice,  16-19 

signs,  14-18 

students,  12,  13 
Offices,  branch,  5 
OJd  lady  with  salve,  170 

persons,  operations  upon,  328 
Old  woman  of  Paris,  151 
Omen,  a  bad,  137 
Omission  vei'S'is  commission,  163 
Only  sprained.  330 
Only  drunk,  330 
Opiates,    their    place    and   power,    156, 

157 
Opinions,  necessity  for  caution  in    giv- 
ing, 53,  123,  '324,  325,  329.  330 

of  patients  and  their  attendants  to 
be  considered,  186 

that  terrify,  175-178 
Other  physicians,  attending  after,  64,  65, 

103,  104,  308 
Overlooking  diseases,  157,  158 
Overpraise  from  patients,  119,  120 

from  relatives,  120 
Overvisiting,  123,  143,  144 

Panama  beans,  197 

Partisan  questions,  26,  94,  270 

Partnership,  2 

Passions,  influence  of,  147,  148 


INDEX. 


341 


Patients,  dining  with,  96 

distant,  117 

foreigners  as,  41 

hospital  and  dispensary,   compared 
with  private,  60,  61 

how  to  transfer,  209 

physician's    legal    duty  to,   70,    72, 
171 

neglectful  and  perverse,  168 

purse-proud,  154  ^ 

quoting  authorities  to.  111,  112 

refusal  to  take,  171,  172,  313,  314 
Patients,  rights  of,  to  additional  advice, 
214 

varieties  of,  141,  193,  194,    381,   333 

whims  gratified,   50,   168,   186,   239, 
240,  242 

worthless,  146,  313,  314 
Pay  you,  when  shall  I '?  287 
Paying  one's  debts,  91 
Peculiarity  of  manner,  52 
Pencil  sketches,  160 
Penmanship,  41 

Pension  claimants,  certificates  to,  75 
Percentage  from  pharmacists,  260,  261 
Personal  afRxirs,  privacy  regarding  your 
own,  321 

appearances,  21,  22,  23 
Pharmaceutical  catch-pennies,  204,  205 
Pharmacists,  259-279 

indiscreet,  266 

prescribing,  265,  311 
PharmacopcBia,  breadth  of  the  U.  S.,  272, 

273 
Phlegm,  swallowing,  186 
Photograph  giving,  130 
Physician,  a  sickly,  45 

estate  of  deceased,  318,  319 

how    an  irregular   may    become    a 
regular,  219 

mission  of  the,  140,  214,    309,  333, 
334,  335 

or  doctor  as  a  title,  14 

the  new,  30-33 

versus  doctor  as  a  title,  14 

what  constitutes  a  regular,  217,  219 
Physician's  countenance,  the,  174,  324, 

325,  330 
Physicians,  assaults  upon,  165 

associates  of,  10,  11 

drunken,  11,  93,  94 

increase  of  number  of,  34,  35 

sickly,  45 

taking  office,  23,  24,  25 

the  marriage  of,  97 

why  the  older  excel  the  younger, 
107-109 

why  they  do  not   get  rich,   316-321 

young,  4 
Placebos,  150,  151 
Pocket  visiting-list,  18 
Policy  versus  Principle,  168,  243 


Politeness,  value  of,  38,  89,  xOO 

Politics,  9,  25 

Pollution,  self,  182 

Polypharmacy,  202 

Poor,  attending  the,  57,  58,  59,  309,  312, 

322 
Popular  test  of  skill,  49,  86,  88 
Posting  one's  books,  287,  290 
Post-mortem      discolorations,      popular 

error  regarding,  326 
Post-mortems  and  analyses,  113,  114,  326 
Practice,    difterence    between    limiting 
one's,   and   limiting  one's   creed, 
230 
limiting  amount  of,  117 
Practice,  preparing  one's  self  for,  3,  45 

soliciting,  153 
Precautions,  157,  164 
Pregnancy  suspected,  78,  79,  158 
Prescribing,  extravagance  in,  174,  175 
suggestions  on  tlie  subject  of,   156. 

157       ' 
without  an  interview,  221 
Prescription,  object  of  a,  262 
papers,  260 

the,   to  whom  does  it  belong?   262 
Prescriptions,  about  labeling,  205,  206, 
277,  278 
expertness   in  writing,   42,  43,  191, 

202 
joint,  206 
ready  written.  111 
unauthorized  renewal  of,  262 
Presents  from  patients,  95 
Press  notices,  104 

from  physicians,  104 
writing  for  the  medical,  88-91 
Principle  versus  Polic3^  168,  243 
Private  formulae,  use  of,  261 
Production  of  abortion,  77,  78,  79 
Profession,  identifying  self  with  the,  80, 

81 
Professorship,  choice  of  a,  25 
Prognosis,  cautions  concerning,  53,  110, 

111,  121.  138,  139,  160,  325,  330 
Provings,  homoeopathic,  252 
Purgative  after  confinement,  191 
Purity  of  mind,  46 

Quack  bitters,  130 

medicines,  their   proper  position  in 
the  apothecary-store,  277 
relation  of  pharmacists  to,  265,  274 
Quackery,  ours  the  age  of  233 
Quackish  methods,  28 
Quacks  and  impostors,  depredations  by, 

172,  180,  233 
Quantities  to  prescribe,  174 
Question,  an  awkward.  111 
Questions,  asking  private,  119 
rule  for  repeating,  192 
rule  regarding,  47,  158 


342 


INDEX. 


Questions,  unwelcome,  how  to  avoid,  139 
Quinine,  popular  prejudice  a.itainst,  196 
Quoting  what  the  books  say.  Ill,  112 
Quotations  at  beffinnino;  of  chapters,  1, 

34,  77,  106,131,  163,  193,  208,  227, 

259,  280,  324 

R  as  a  sign  or  symbol,  43 

Receipts,  why  compel  people  to  take,  305 

Reclaiming  those  who  have  strayed,  232, 

233 
Recommending  other  physicians,  172 
Record-book,  159 

Recreation,  necessity  of,  101,102,  103 
Reference-book,  159 
Register  heat,  184 
Religion,  131-141 

Relinquishing  attendance,  142,  212,  214 
Remedies,  domestic,  indorsing,  169 

examined  at  every  visit,  202 

horrifying,  195 
Removals,  frequent,  5 
Renewal  of  prescriptions,  to  prevent,  205 
Reporting  cases,  88,  89 
Reputation,  value  of,  44,  45 

varieties  of,  29,  44 
Responsibility,  dividing  the,  162,  163 
Rich  not  to  pay  for  poor,  294 

the  poor  who  get,  154 
Riding  versus  walking.  26 
Rivalry,  professional,  31,  32,  35 
Routine  practice,  43 
Rule  for  repeating  questions,  192 

the  golden,  36,  62 
Ruling  spirits  in  family,  the,  120 

Scandal,  36,  46.  47,  157 
Scarlet  rash,  187 

Scold,  how  to,  without  offendina:,  97 
Secrets,  119,  146,  147,  148 
Selection  of  a  location,  3-6 
Self-medication.  203,  204 
Self-pollution,  182 
Self-preservation,  30,  31 
Self-reliance,  its  value,  208 
Seniors,  respects  due  our,  106-109 
SequeUe,  foreseeing,  330 
Servants,  attending,  59 
Services  for  emploj^ers,  285 

to  clergymen,  271,  307 

to  physicians,  307 

to  the  poor,  57,  58,  309,  310,  322 

when  not  to  charge  for,  306,  307 
Sextial  intercourse,  why  never  recom- 
mend, 181 
Shame,  a  matter  of.  166 
Short  visits,  how  to  make,  122,  200 
Shut  your  eyes,  to  these,  187 
Sick,  humoring  the,  50 
Sickly  physicians,  45 
Signatures,  regarding,  251 
Signs,  office,  14,  15 


Skill,  what  is  medical,  43,  56,  222,  223, 

332,  333 
Slavery  of  a  physician's  life,  101,  102, 103, 

315-320 
Small-pox,  popular  error  regarding  the. 

71 
Social  influence,  100 
Society,  duty  to,  148 
Soliciting  practice,  155 
Something  to  avoid,  79 
Speaking-lube,  17 

Specialties,  when  to  patronize,  208,  209 
Specialty,  adoption  of  a,  59 
Specifying  the  particular  make,  273 
Speculum,  abuse  of  the  vaginal,  177,  179 
Spoons,  variations  in  size  of,  206 
Sprain,  fracture  or  dislocation,  330 
Spring-time,  taking  medicine  in  the.  152 
Stepping-stones  to  practice,  57,  58,  59 
Streets,  barricading  or  roping  the,  192 
Students,  increase  of  13,  34 
Suffixes,  adding  to  one's  name,  91 
Sunday  as  a  day  of  rest,  102,  279,  287 
prescribing  liquor  on,  95 
practicing  on,  102,  103 
Superseding  other  physicians,  64,  65, 103, 

104,  308 
Suppressing  chronic  discharges,  188 
Surgeons,  why  demand  for,  is  limited, 

51 
Surprise,  showing,  324.  325 
Syphilitic  cases,  175,  299,  300.  301 
Syphilitics,  the  marriage  of,  181 
\  System  in  business,  9 
j  Swallowing  foreign  bodies,  189 
I         phlegm,  186 
Swearing  off  from  drink.  129 
Sweating  during  sleep,  200 

the  baby,  185 
Synonyms,  use  of,  204,  276,  277 

Telephone,  the,  17 
Temper,  control  of,  53,  101 
Terms,  transposing,  277 
Terrifying  opinions,  175-178 
Therapeutics,  crude,  193,  194 
mental,  150,  151,  193,  194 
Thermometer,  clinical,  21 
Time,  rapid  flight  of  a  physician's,  101 
Time  lost  in  waiting,  201 
Toleration  of  difference  of  opinion,  84 
Tongue-depressors,  128 
Trade-mark  articles,  204,  272,  273 
Transposing  terms,  277 
Tricks,  28,  33,  121 
Trips  for  health,  198,  199 
Triumphs,  65 
Truth,  its  value,  138,  249 

Unction,  extreme,  134 

Urinary  diseases,  179,  328 

Urine,  scanty  and  high  colored,  189 


INDEX. 


343 


Vacation,  the  physician's,  101,  103,  103 

Vaccination,  70/71 

Value  of  politeness,  98,  99,  100 

of  reputation,  43,  44 
Variability  of  human  endurance,  333 
Variation  in  tlie  size  of  spoons,  30(3 
Varieties  of  patients,  193,  194,  331 
Vegetable  versus  mineral  medicines,  196 
Veins  ou  back  of  hands,  191 
Venerea]  cases,  117,  118,  399,  300,  301 
Visit,  conduct  at,  46-56 

extra  cluirge  for  the  first,  394 
Visiting-list,  best  way  to  carry  one's,  389 

how  to  improve  a,  388 
Visiting   the  patient  of  another   physi- 

c'ian,  64,  65,  103.  104,  139 
Visitors  to  the  siclv,  191 
Visits,  how  to  make  short,  133,  300 

neighborly,  31,  80 

to  the  sick,    49,   130,  143.  144,    191, 
193 
Vivisection,  114 

Vocabulary  of  different  classes,  331 
Volunteer  services,  71 


Waiting,  time  lost  in,  301 

Walking  versus  riding.  36,  37 

Warming  the  newborn.  184,  185 

Wars  of  competition.  393 

What  is  in  a  name  ?  349,  350,  351.  353 

Whims,  gratifying  the,  of  patients,  50, 

168 
Why  charge  for  every  visit,  395 
Wife,  the  meddling,  146 
Wills,  136,  137 

Wiseacres  and  critics,  173,  174,  303 
Withdrawal  from  a  case,  155 
Witness,  duty  to  self  when  a,  73 
Woman,  devotion  of  to  the  sick,  56 
Womb-doctoring.  176 
Work,  amount  of  done  by  every  busy 

physician.  315-319 
Worms,  has  he  ?  186 
Worthless  patients,  171 

systems  of  practice,  how  to  expose, 

333 
Writing  for  tlie  medical  press,  88-91 

Youthful  physicians,  4,  111,  113 


i 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 

Los  Angeles 
This  book  is  DUE  on  the  last  date  stamped  below. 


m^ 


BIOKEO.  LIB. 

BIOMED   AUG  2  1  198; 
;  .WED  Uii 

AUG  0  8  R 
B18Mti.„tp23'87 

BlOMED  UB. 

MAR  1 3  1981 

REC'O 


Form  L9-10m-9, '54(741354)444 


3  1158  00877  3557 


J»^ 


